Review of Texas Physical Therapist's Medicare Claims for Therapy Services Provided During 2002

The objective of this review was to determine whether therapy services provided by a Texas physical therapist during calendar year 2002 met Medicare reimbursement requirements.  None of the sampled claims met Medicare's reimbursement requirements.  In total, 688 of the 702 services documented in 97 claims did not meet one or more of Medicare's reimbursement requirements.  The physical therapist did not have a thorough understanding of Medicare requirements and did not have effective policies and procedures to ensure that he billed Medicare only for services that met Medicare requirements.  As a result, the physical therapist improperly billed Medicare and received $12,652 for the 688 services.

We recommended that the physical therapist refund to the Medicare program $281,325 in unallowable payments for therapy services provided in 2002 and develop quality control procedures to ensure that therapy services are provided and documented in accordance with Medicare reimbursement requirements. The physical therapist did not agree with our findings and recommendations.