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EXECUTIVE SUMMARY:
The objective of our review was to determine whether inpatient rehabilitation facilities (IRFs) under the administrative responsibility of United Government Services, LLC (UGS) billed fiscal year-end inpatient rehabilitation claims in accordance with Medicare requirements during the transition to the prospective payment system in 2002. Thirty-four IRFs did not bill 340 fiscal year-end claims in accordance with Medicare requirements. As a result, Medicare made net overpayments of $516,303. Some IRFs did not have adequate controls to ensure that claims submitted at fiscal year-end were billed accordance with Medicare requirements, and two IRFs stated that they had received inaccurate information from UGS.
We recommended that UGS make the appropriate adjustments to paid claims that resulted in net overpayments of $516,303 to the 34 IRFs and continue education efforts for IRF and UGS personnel. UGS agreed with our recommendations.