In August, the Office of Inspector General (OIG) released a report entitled, Fox Rehabilitation Claimed Unallowable Medicare Reimbursement for Outpatient Therapy Services (A-02-16-01004). 

The report states that Fox Rehabilitation, one of the largest outpatient therapy providers in the country, claimed $29.9 million in unallowable Medicare reimbursement for outpatient therapy services performed in New Jersey alone. The report further states that the OIG’s review covered claims for outpatient therapy services provided by Fox in New Jersey from July 2013 through June 2015, totaling $39.7 million. The OIG reviewed a random sample of 100 of these claims to determine whether services complied with Medicare medical necessity, documentation, and coding requirements. The OIG found that for 85 of the 100 claims in the random sample, Fox improperly claimed Medicare reimbursement for outpatient therapy services. Based on medical review, the OIG determined that all 85 claims had services that were not medically necessary, and for nearly all of these claims, the amount, frequency, and duration of services were not reasonable and consistent with acceptable standards of practice. Moreover, some services did not require the skills of a licensed therapist or were not an effective treatment for the Medicare beneficiary’s condition. The OIG stated that this occurred because Fox did not follow its policies and procedures to ensure that services complied with Medicare requirements. On the basis of their sample results, the OIG recommended that Fox refund $29.9 million to the Federal Government and ensure that outpatient therapy services are provided and documented in accordance with Medicare requirements.