Medicare Compliance & Reimbursement

Plus: Not-guilty verdict in Medicare fraud case.

The newly elected 110th Congress hasn't forgotten about therapists' and their patients' cries for help. On Feb. 1, Congress re-introduced legislation S. 450/H.R. 748, the Medicare Access to Rehabilitation Services Act of 2007, according to the American Physical Therapy Association (APTA).

This bill seeks to completely repeal the therapy cap on outpatient physical therapy benefits, as opposed to the current system where therapists may file for exceptions--which expires at the end of the year.

"Passing this important legislation to completely repeal the therapy caps is the best long-term policy solution--rather than passing '1-year fixes'--to protect the Medicare beneficiaries who need rehabilitation services the most," commented APTA President R. Scott Ward, PT, PhD.  

Watching your back: Sens. John Ensign (R-NV), Blanche Lincoln (D-AR), Ben Cardin (D-MD), and Susan Collins (R-ME) and Reps. Xavier Becerra (D-CA, 31st), Phil English (R-PA, 3rd), Mike Ross (D-AR, 4th), Chip Pickering (R-MS, 3rd) and Roy Blunt (R-MO, 7th) introduced legislation and continue to advocate in your favor.

"I urge my colleagues to support this because we should not limit the therapy and recovery options available to our nation's seniors, especially the oldest and sickest on Medicare," Sen. Ensign said.

Current law limits Medicare coverage of outpatient therapy services in 2007 to $1,780 for physical therapy and speech language pathology and $1,780 for occupational therapy. 

Ohio Couple Found Not Guilty For Fraudulent Billing

What appeared to be a stiff prison sentence on the horizon for radiologist Robert Reither and his wife Judy is now cleared.

The background: The Reithers were accused of fraudulently billing Medicare for modified barium swallow (MBS) tests. A federal grand jury returned a 13-count indictment that said the Reithers billed Medicare for more than $6 million and received $3.7 million for non-covered services.

The result: Last December, a two-week jury trial found both Robert and Judy Reither not guilty on all counts and the indictment, the couple's attorney informed Eli in a letter.

For details on the case, see case no. 5:06CR254 from the U.S. District Court for Northern Ohio.