Alleged overpayments to inpatient rehab facilities spark CMS review

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Inpatient rehab facilities received an estimated $34 million in overpayments from Medicare between 2004 and 2007, according to a report from the Office of Inspector General. This has prompted a review by the Centers for Medicare & Medicaid Services.

The original sample size for the OIG report was 5,700 claims, totaling $103 million in payments. Of the 220 IRF claims the OIG reviewed for its report, 213 were incorrectly coded, resulting in $1.2 million in overpayments. CMS should recoup the $1.2 million in overpayments, and initiate a review process for the remaining claims and estimated $34 million in overpayments, the OIG recommended.

Also among the findings of the GAO report: Despite changes made to the Common Working File in April 2007 that help identify improperly coded claims, no action has been taken to correct those payment rates.