Fox Rehabilitation, one of the largest outpatient therapy providers in the U.S., improperly claimed $29.9 million in Medicare Part B payments, according to an audit by HHS' Office of the Inspector General.
The Cherry Hill, N.J.-based rehab facility provides physician, occupational and speech therapy to geriatric patients who are largely chronically ill or have multiple co-morbidities, Alzheimer's disease or dementia.
OIG reviewed more than 400,000 outpatient therapy service claims, totaling $39.7 million, that Fox Rehab filed from July 2013 to June 2015. OIG medical and coding reviewers examined a random sample of 100 Medicare Part B claims filed by Fox Rehab during the audit period and found 85 represented improper claims.
OIG said the errors reflected claims for therapy services deemed medically unnecessary and noncompliant with Medicare documentation and coding requirements. Federal officials said some administered services did not require a licensed therapist or were not an appropriate treatment given the beneficiaries' diagnoses. OIG added the improper claims' amount, frequency and length of services were "not reasonable and consistent with acceptable standards of practice."
OIG recommended Fox Rehab refund the federal government the specified payments and work to ensure future Medicare documentation and outpatient therapy services are in accordance with program requirements.
Fox Rehab refuted the OIG's findings and recommendations, questioning the sampling methodology used in its review. In its response, Fox Rehab stated, "Contrary to the OIG's bald claim, Fox's clinicians consistently follow the internal policies and procedures that Fox has implemented to assure the appropriate quality of patient care and accurate billing for services."
OIG maintained its findings and recommended retribution after reviewing Fox's comment.
In a statement to Becker's Hospital Review, Fox Rehab said, "For nearly 20 years, Fox Rehabilitation has been focused on helping our clients achieve optimal function and combat ageism. In serving this mission, we have always operated our business in compliance with all applicable regulations and in cooperation with all Medicare requirements. We vehemently disagree with the OIG's report and will appeal all of the claims that were denied by the Office of Inspector General. We look forward to continuing to provide clinically excellent care and remain dedicated to using appropriate therapy to restore and rehabilitate lives."
Editor's note: This article was updated to include a statement from Fox Rehabilitation.