Report: Medicare making questionable rehab payments

WASHINGTON -- Well over half the Medicare payments made to outpatient rehabilitation facilities over a one-year period were questionable in nature, according to a six-state review released today.

The inspector general of the Department of Health and Human Services inspector general said that of $263 million paid out for outpatient rehab in the six states in the year ending June 30, 1998, $173 million was for ''unallowable or highly questionable'' services.

''Outpatient rehabilitation services are vitally important for countless people,'' said Sen. Tom Harkin of Iowa, ranking Democrat on the Appropriations subcommittee that funds the Medicare program. ''That's why we can't undermine support for them due to fraud, waste and abuse.'' Harkin, whose office released the report, noted that one facility submitted a claim for payments to a credit card for boating-related expenses and trips to the Caribbean.

The six states surveyed -- Florida, Louisiana, Michigan, New Jersey, Pennsylvania and Texas -- represent nearly half the $572 million that the Health Care Financing Administration, the agency that runs Medicare, paid for outpatient rehab services nationwide in 1997.

The report found that of 192 claims medically reviewed, 66 claims were not reasonable and necessary for the patient's condition and 36 claims were inadequately documented.