A federal review of outpatient physical therapy payments found Medicare likely overpaid $367 million during a six-month period.
The Department of Health and Human Services’ Office of Inspector General examined a random sample of 300 claims and found 61% did not meet medical necessity, coding or documentation requirements. The OIG issued its report in March, extrapolating that the same rate of improper payments that led to almost $13,000 in reimbursement over a six-month period would equate to $367 million system-wide.
The office’s three recommendations included instructing Medicare Administrative Contractors to notify providers of potential overpayments (with the possibility of returning them), establishing ways to better monitor the appropriateness of outpatient physical therapy claims and educating providers about requirements for submitting such claims
The Centers for Medicare & Medicaid Services argued that further analysis would be needed to determine if claims actually met Medicare requirements.