Federal Reports

A Missouri physical therapy practice (the Therapy Practice) claimed Medicare reimbursement for some outpatient physical therapy services that did not meet Medicare reimbursement requirements. Of the 100 beneficiary days in our random sample, the Therapy Practice properly claimed Medicare reimbursement on 65 beneficiary days. The Therapy Practice improperly claimed Medicare reimbursement on the remaining 35 beneficiary days. On the basis of our sample results, we estimated that the Therapy Practice improperly received at least $151,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements. Accordingly, we made procedural and monetary recommendations to the Therapy Practice.

Before the start of our audit, the Iowa Department of Human Services, Iowa Medicaid Enterprise (State agency), did not invoice rebate-eligible physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations (MCOs) in the State. Specifically, the State agency did not invoice drug manufacturers for rebates totaling $709,000 ($401,000 Federal share). These errors occurred because the State agency was still in the process of developing policies and procedures to ensure that it accurately invoiced manufacturers to collect rebates for physician-administered drugs dispensed to enrollees of MCOs.

FY 17 annual improper payments report to OMB and Congress.