Illinois Physical Therapist Claimed Unallowable Medicare Part B Reimbursement for Outpatient Therapy Services

摘要

In recent years, outpatient physical therapy payments have increased annually with total payments to physical therapists in private practice (therapist) totaling $1.7 billion in Calendar Year (CY) 2011. Past Office of Inspector General (OIG) reviews have identified claims for outpatient physical therapy services that were not reasonable, medically necessary, or properly documented, and vulnerable for fraud, waste, and abuse. After analyzing Medicare claims data for CY 2011, we selected multiple physical therapists for review, including this therapist located in the State of Illinois. Our analysis indicated that, among other selected criterion, this selected therapist was among the highest Medicare therapy billers in the State of Illinois. Our objective was to determine whether outpatient physical therapy services provided by an Illinois physical therapist in private practice were paid in accordance with Medicare requirements.