[Congressional Record Volume 145, Number 164 (Thursday, November 18, 1999)]
[Extensions of Remarks]
[Page E2446]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  STOPPING ABUSE OF COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY 
                                PROGRAM

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, November 17, 1999

  Mr. STARK. Mr. Speaker, one of the good services in Medicare is the 
CORF (Comprehensive Outpatient Rehabilitation Facility) program, where 
beneficiaries recovering from an illness or operation can get a wide 
range of quality rehab services.
  Unfortunately, there appears to be a loophole in the law allowing the 
establishment of ``satellite'' CORFs. In this scheme, doctors are 
getting letters offering to rent part of their office for the placement 
of a therapist. The rent offered is often sight-unseen and is far above 
what is a reasonable rental rate. It is, in my opinion, a violation of 
the anti-kickback laws and is a way to get referrals that greatly 
drives up utilization and costs for Medicare.
  To stop this proliferation of services we never knew we needed, I am 
introducing a bill, with an effective date of today, to require that 
all CORF services be provided at one site. I submit a letter from the 
HCFA Deputy Administrator on this issue and on the steps Medicare is 
taking to avoid fraudulent utilization in this area. The Administration 
is to be commended for its efforts to prevent abuse in this area--but 
clarifying the law will also be helpful.

         Department of Health and Human Services, Health Care 
           Financing Administration, Deputy Administrator
                                    Washington, DC, Oct. 27, 1999.
     Hon. Pete Stark,
     House of Representatives, Washington, DC.
       Dear Mr. Stark: Thank you for your letter to the 
     Administrator regarding contracts being mailed to doctors to 
     open uncertified mini-Comprehensive Outpatient Rehabilitation 
     Facilities (CORFs) in physicians' offices. I am responding on 
     her behalf, and I apologize for the delay in this response. 
     You also stated that you earlier copied the Administrator on 
     a letter you sent to the Department of Health and Human 
     Services' (DHHS') Office of the Inspector General regarding 
     this matter. You are requesting that the Administrator 
     immediately put a halt to the proliferation of these 
     ``satellite'' CORFs.
       I share your concern with the apparent proliferation of 
     satellite CORFs. Based on the information furnished, the 
     establishment of satellite facilities is consistent with 
     section 1861(cc) of the Social Security Act (the Act). 
     Section 1861(cc)(1) of the Act states that in the case of 
     physical therapy (PT), occupational therapy (OT), and speech 
     pathology (SP) services there shall be no requirement that 
     the item or service be furnished at any single, fixed 
     location. All other CORF services must be provided at the 
     site of the CORF approved for Medicare participation.
       It should be noted that although the Act exempts these 
     services from the single, fixed location requirement, it does 
     not exempt them from any of the other CORF requirements. 
     Since the CORF must make documentation available to the state 
     survey agency surveyor demonstrating that it furnishes all 
     services in compliance with the CORF requirements, we would 
     expect the documentation at the CORF for services furnished 
     off-site would not be unlike that for services furnished at 
     the CORF. Also, state survey agencies are not precluded from 
     making visits to the off-site locations as necessary, to 
     ensure that the CORF requirements are met.
       Recently, a briefing on CORFs and outpatient rehabilitation 
     facilities was held for Kevin Thurm, Deputy Secretary of 
     DHHS. I presented the Health Care Financing Administration' 
     (HCFA's) program integrity action plan based on analysis we 
     had initiated with the HCFA Miami Satellite Office. The plan 
     includes intensified medical review in targeted areas, 
     education of providers and fiscal intermediaries, and 
     increased reviews of off-site locations. I believe these 
     interventions and the increased oversight will curb 
     inappropriate growth of the providers until HCFA is granted 
     statutory authority to require that PT, OT, or SP be 
     furnished at a single, fixed location.
       Thank you for your interest in this matter.
           Sincerely,
                                                  Michael M. Hash,
                                             Deputy Administrator.

     

                          ____________________