关键词：医疗补助;治疗服务;支付;不当支付州(美国);问卷调查;付款保障;建议
摘 要：Past Office of Inspector General work has shown that Medicare- and Medicaid-paid physical, occupational, and speech therapy services were vulnerable to improper payments because (1) plans of care were incomplete or missing; (2) documentation was missing, or providers failed to respond to our request for documentation; or (3) providers lacked proper qualifications, or we could not determine whether they had proper qualifications. We asked Medicaid staff from all States and the District of Columbia (States) to respond to a questionnaire requesting information about whether their States placed limits on therapy services, and if so, the nature of those limits. We examined paid Medicaid fee-for-service claims for therapy services in eight States (Arkansas, Florida, Hawaii, Illinois, Maine, Maryland, Michigan, and North Carolina) for the period July 1, 2008, through June 30, 2009, to determine whether the therapy services complied with State limits. We asked State Medicaid officials to describe the safeguards established to prevent payments in excess of State limits. We also asked State Medicaid staff to identify the reason(s) States safeguards failed to prevent payments in excess of State limits.