Comprehensive Outpatient Rehabilitation Facilities: High Medicare Payments in Florida Raise Program Integrity Concerns
Highlights
Comprehensive Outpatient Rehabilitation Facilities (CORF) are highly concentrated in Florida. These facilities, which provide physical therapy, occupational therapy, speech-language pathology services, and other related services, have been promoted as lucrative business opportunities for investors. Aware of such promotions, the Chairman, Senate Committee on Finance, raised concerns about whether Medicare could be vulnerable to overbilling for CORF services. In this report, focusing our review on Florida, we (1) compared Medicare's outpatient therapy payments to CORFs in 2002 with its payments that year to other facility-based outpatient therapy providers and (2) assessed the program's effectiveness in ensuring that payments to CORFs complied with Medicare rules.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Medicare & Medicaid Services | To ensure that Medicare only pays for medically necessary care as outlined in program rules, the Centers for Medicare and Medicaid Services should direct the Florida claims administration contractor to medically review a larger number of CORF claims. |
CMS officials reported in August 2005 that the agency has not taken any action to implement the recommendation. In July 2006, CMS officials agreed that disproportionately high payments to CORFs indicate a need for medical review of these providers, but asserted that the contractor is already taking appropriate steps to address the problem.
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