HHS' Office of Inspector General found Northside Medical Center in Youngstown, Ohio, submitted erroneous bills to Medicare for treatment of severe malnutrition.
For the audit period of Jan. 1, 2013, through June 30, 2015, the OIG said Northside Medical Center submitted 98 claims to Medicare that used the codes for nutritional marasmus or other severe protein-calorie malnutrition when a different malnutrition code or no malnutrition code should have been used. This resulted in overpayments of $463,619. Extrapolating from the sample results, the OIG estimated Northside Medical Center received at least $1.28 million in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended Northside Medical Center refund the Medicare contractor $1.28 million, exercise reasonable diligence to identify and return any additional overpayments outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements.
In written comments, the hospital agreed that 26 of the 98 claims identified by the OIG contained billing errors. However, the hospital did not agree with the OIG's determination regarding the reaming 72 claims.
After reviewing the system's comments, the OIG maintained its findings and recommendations.
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