Huntsville (Ala.) Hospital and Wesley Medical Center in Wichita, Kan., failed to comply with Medicare billing requirements for certain inpatient and outpatient claims reviewed by HHS' Office of Inspector General.
Huntsville Hospital failed to comply with Medicare billing requirements for 99 of 277 claims reviewed by the OIG during the audit period of Jan. 1, 2013, through Aug. 31, 2014. The 99 improperly billed claims resulted in the hospital receiving $23,757 in overpayments. Extrapolating from the sample results, the OIG estimated Huntsville Hospital received at least $203,226 in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended Huntsville Hospital refund the Medicare contractor $203,226 and strengthen controls to ensure full compliance with Medicare requirements.
Huntsville Hospital agreed with all but one of the OIG's findings and concurred with the OIG's recommendations. After reviewing the hospital's comments and objections, the OIG maintained its findings and recommendations.
Like Huntsville Hospital, Wesley Medical Center also needs to strengthen its controls to ensure compliance with Medicare requirements, according to the OIG. Of 246 inpatient and outpatient claims submitted during 2012 and 2013 reviewed by the OIG, the hospital failed to comply with Medicare billing requirements for 38 claims. The improperly billed claims resulted in a net overpayment of $181,600.
The OIG recommended Wesley Medical Center refund the Medicare contractor the overpayment. The hospital submitted written comments to the OIG describing the corrective actions it has taken, including strengthening internal controls and processing refunds to the Medicare contractor.
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