OIG: CMS should determine whether $3 million in payments were allowable
Compliance Monitor, March 29, 2006
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The OIG has recommended in an audit that CMS determine whether $3 million in questionable payments that Synergy Rehab Services Inc. submitted for reimbursement were allowable.
The OIG's audit objective was to determine whether the claims that Synergy Rehab Services Inc. of Baton Rouge, LA submitted for partial hospitalization program (PHP) services met Medicare reimbursement requirements.
For 51 of 100 sampled claims, medical reviewers determined that Medicare reimbursement requirements were not met, primarily for two reasons: (1) the patient did not need, or was unable to benefit from, the services; and (2) the patient's medical records lacked the required documentation.
Synergy Rehab strongly disagreed with the OIG's findings and took issue with many aspects of the review, including the audit-review process and the medical determinations.
The OIG has issued the final report directly to CMS for resolution.
To complete the audit, the OIG
Click here to read the audit report, "Medical Review of Synergy Behavioral Health's Partial Hospitalization Services for the Period August 1, 2000, through December 31, 2002," (A-06-04-00076) issued March 9, 2006.
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