Spectrum Rehabilitation, LLC, Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services

October 28, 2013
 / 
Rick Gawenda
 / 

The Office of the Inspector General (OIG) has released a report regarding the billing of and reimbursement for outpatient therapy services by Spectrum Rehabilitation, LLC (Spectrum). The OIG estimates that Spectrum, operating in New Jersey, improperly received at least $3.1 million in Medicare reimbursement for outpatient occupational and physical therapy services that did not comply with certain Medicare requirements.

Of the 100 claims in our random sample, Spectrum properly claimed Medicare reimbursement for 17 claims. However, Spectrum improperly claimed Medicare reimbursement for the remaining 83 claims. Of these 83 claims, 44 contained more than 1 deficiency. Deficiencies included Medicare physician certification requirements were not met, treatment notes did not meet Medicare requirements, the therapist who billed for the services did not provide or supervise the services, the therapy services were not medically necessary, and the plan did not meet Medicare requirements.

On the basis of our sample results, the OIG estimated that Spectrum improperly received at least $3,112,501 in Medicare reimbursement for outpatient occupational and physical therapy services that did not comply with certain Medicare requirements.

To read the OIG full report, click HERE.


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