Medicare Compliance & Reimbursement

OIG orders millions of dollars of refunds from IRFs for Medicare overpayments.

If you're a Medicare inpatient rehabilitation facility (IRF), you may want to take another look at the patients you're admitting.

The HHS Office of Inspector General (OIG) released on May 1 two reports (of Whittier Rehabilitation Hospital and Catholic Medical Center for calendar year 2003) that reviewed whether the hospitals submitted IRF claims that met Medicare requirements--and both fell short by a long shot.

Reason: "An IRF was not the appropriate setting" for nearly 50 percent of the beneficiaries in a claim sampling from both hospitals.

Recommendation: Needless to say, the OIG recommended that both facilities refund Medicare the resulting overpayments, which add up to the millions. Whittier is looking at a $4.8 million figure, and Catholic is looking at approximately $1.7 million.

The OIG also recommended that both facilities strengthen their preadmission screening procedures "to provide reasonable assurance that beneficiaries who are admitted for IRF services require treatment at the IRF level of care, are capable of significant practical improvement, and are able to participate in intensive rehabilitation." 

Both hospitals "strongly disagreed with our findings and recommendations," the OIG said.

You can view the full reports for more details at www.oig.hhs.gov/oas/reports/region1/10400531.pdf and www.oig.hhs.gov/oas/reports/region1/10400530.pdf.