OIG report finds PCH didn't provide medical necessity on claims
Rehab Regs, July 28, 2006
A June 28 report by the Office of Inspector General (OIG) looked at 114 PT and OT claims filed by PCH Health Systems in California from 2000 to 2003, none of which met Medicare's reimbursement requirements.
The report said most of the claims had several errors on them, and 103 claims were for medically unnecessary services. Another 11 did not have enough documentation to support medical necessity.
The 114 reviewed claims resulted in PCH receiving $41,124 in unallowable claims, and the OIG recommended that PCH refund Medicare nearly $10 million of the more than $11 million it collected over that time span.
To read the entire OIG report click here.
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