The Office of Inspector General (OIG) issued a report of an audit that reviewed their cardiac, intensive cardiac, and pulmonary rehabilitation (CR/ICR/PR) programs. As you may remember there was an OIG audit in 2015 of cardiac and pulmonary services (CR/PR) and identified claims for these services did not comply with Federal requirements.
The objective of this audit was to determine whether CMS regulatory requirements contained sufficient information to ensure that claims for CR/ICR/PR complied with Medicare coverage requirements. One hospital was selected to review an audit period covering April 2016 through March 2018.
The OIG’s conclusion was that CMS’s regulatory requirements may not be sufficient to ensure providers complied with the intent of the Medicare coverage requirements. More details about specific findings are found in the report.
The recommendation from the OIG was that CMS should revise the regulations to ensure that providers meet coverage requirements. The CMS response to this recommendation was that such changes would require notice and a public comment period and that consideration would be given to CMS’s next steps.
We are uncertain what the next steps will be. AACVPR is very aware of this issue and we will keep the NCCRA membership aware of any communications or additional information that comes to light.
See a copy of the report here: OIG report 5-2021