"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, February 25, 2010

RACs refer two Rehab Providers for Fraud

A new report by the Office of the Inspector General reveals during the Recovery Audit Contractor Demonstration period from March 2005 to March 2008 in Florida, California and New York that two rehabilitation service providers were referred to the Centers for Medicare and Medicaid Services (CMS) for possible fraud.

The RACs are not responsible for reviewing claims for fraudulent activity only for identifying improper payments.
The two referrals involved rehabilitation service providers and both involved suspected alterations of medical records after the services were rendered.

According to the RAC referral letters sent to CMS, the RAC had no contact with the providers in reference to the allegations and continued to complete its complex and/or automated, postpayment review of the providers.

If CMS had determined that the referrals were potentially fraudulent, the RAC should have ceased its review of these claims.
More Medicare audit resources are found here.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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