Fox Rehabilitation received at least $29.9 million in Medicare Part B payments for services that did not meet Medicare requirements, according to an August report by the Office of the Inspector General of the U.S. Department of Health and Human Services.
The Cherry Hill, NJ-based rehab facility provides outpatient physical, occupational and speech therapy services to geriatric patients who are chronically ill or have multiple comorbidities.
The OIG reviewed more than 400,000 Medicare Part B claims for outpatient therapy services, totaling $39.7 million, which Fox Rehab filed between July 2013 and June 2015. Medical and coding reviewers found that 85 of a random sample of 100 of these claims included services that were not medically necessary, the report alleged.
“For nearly all of these claims, the amount, frequency, and duration of services were not reasonable and consistent with acceptable standards of practice,” the report noted. “Further, some services did not require the skills of a licensed therapist or were not an effective treatment for the Medicare beneficiary’s condition.”
The agency recommended that Fox refund the federal government $29.9 million and work to ensure future Medicare documentation and services are in accordance with program requirements.
Fox disagreed with the OIG’s findings and recommendations, asserting that its internal compliance program ensures that outpatient therapy services are provided and documented in accordance with Medicare requirements.
“For nearly 20 years, Fox Rehabilitation has been focused on helping our clients achieve optimal function and combat ageism,” Fox said in a statement. “We will appeal all of the claims that were denied by the OIG and we look forward to continuing to provide clinically excellent care and remain dedicated to using appropriate therapy to restore and rehabilitate lives.”
From the October 01, 2017 Issue of McKnight's Long-Term Care News
