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EXECUTIVE SUMMARY:
The objective of this review was to determine whether Medicare properly reimbursed Central Florida Regional Hospital for outpatient cardiac rehabilitation services. We found that the hospital did not designate a physician to supervise the services provided through its cardiac rehabilitation program. In addition, we could not identify the physician professional services to which the cardiac rehabilitation services were provided “incident to.” From our claims review for 30 sampled beneficiaries who received outpatient cardiac rehabilitation services during calendar year 2001, we determined that the hospital received Medicare payments of $2,003 for services provided to beneficiaries where medical documentation may not have supported Medicare covered diagnoses and for services not otherwise allowable. We recommended that the hospital: (1) work with its fiscal intermediary to ensure that its outpatient cardiac rehabilitation program is being conducted in accordance with the Medicare coverage requirements for direct physician supervision and for services provided “incident to” a physician’s professional service; (2) work with its fiscal intermediary to establish the amount of repayment liability for services provided to beneficiaries where medical documentation may not have supported Medicare covered diagnoses and for services not otherwise allowable; and (3) implement controls to ensure sessions billed to Medicare do not exceed limits.