EXECUTIVE SUMMARY:
The Florida Adult Care Enterprises, a Community Mental Health Center located in Hollywood, Florida, received reimbursement for partial hospitalization program services provided to Medicare beneficiaries. Our audit showed that none of the services provided to a sample of 40 beneficiaries were medically necessary and therefore allowable for reimbursement under Medicare coverage and reimbursement criteria. The services provided were not ordered by a physician, were not provided to eligible beneficiaries and were not properly documented.
Based on the audit, we recommended that the Health Care Financing Administration (HCFA) instruct the fiscal intermediary to recover the $1,709,245 paid to the center for unallowable services to the sample beneficiaries. In addition, HCFA also terminated the center's provider agreement under the Medicare program.