Boca Raton (Fla.) Regional Hospital failed to comply with Medicare billing requirements for 50 inpatient claims reviewed by HHS' Office of Inspector General during the audit period of 2011 and 2012, according to a recent OIG audit report.
Here are five things to know about the audit.
1. The hospital received $514,449 in overpayments for the 50 claims that did not fully comply with Medicare billing requirements, according to the OIG.
2. Based on the sample results, the OIG estimated the hospital received at least $2.6 million in overpayments from Medicare during the audit period.
3. The OIG recommended the hospital refund the Medicare contractor $282,259 in estimated overpayments for the incorrectly billed services that are within the three-year claims recovery period, work with the contractor to return overpayments outside of the three-year recovery period in accordance with the 60-day repayment rule and strengthen its controls to ensure full compliance with Medicare requirements.
4. Boca Raton Regional Hospital did not agree with the OIG's first and second recommendations. The Hospital said claims paid during calendar year 2011 are time-barred from recovery, but stated that the claims are also time-barred from reopening. Additionally, the hospital said it planned to contest the findings for 13 of the 20 inpatient claims paid during calendar year 2012. In regard to the OIG's third recommendation, the hospital described steps it takes to ensure compliance with Medicare billing requirements.
5. After receiving the hospital's comments, the OIG maintained its findings and recommendations.
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