The Medicare program overpaid $367 million to outpatient physical therapists between July 1, 2013, and Dec. 31, 2013, according to a recent audit by the Office of Inspector General.
For its report, OIG reviewed $635.8 million worth of Medicare Part B claims during the six-month period. After examining a stratified random sample of 300 claims, OIG determined 61 percent of the claims failed to comply with Medicare coding, documentation and medical necessity rules.
"These overpayments occurred because the [CMS'] controls were not effective in preventing improper payments for outpatient physical therapy services," OIG asserts.
CMS mostly disagreed with OIG's findings and its recommendation that CMS command the Medicare Administrative Contractors to make providers aware of the possible overpayments and how to return them. CMS said further analysis of the claims is needed.
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