Report Materials
EXECUTIVE SUMMARY:
The primary objective of the review was to evaluate the medical necessity of the care and services provided and the reasonableness of the charges and reimbursements made during the period from November 1, 1994 through December 31, 1995.
The Operation Restore Trust reviewers questioned $47,229 in charges reported for the 28 sample beneficiaries in our study. This amount included $32,420 related to physical, occupational, and speech therapy services not rendered; $10,180 of unallowable respiratory therapy services; $270 in unallowable pharmacy charges; $310 in inappropriate physician payments; $441 in undocumented x-ray charges; and $3,598 in inappropriate psychiatric services. Therefore, we are recommending an adjustment of the above charges. In addition, we request that a focused review of all rehab therapies and the use of standing orders for these therapies be conducted by the Fiscal Intermediary and State agency in order to recoup overpayments made to this skilled nursing facility and to implement corrective action by the facility.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.