The HHS Office of Inspector General has released three reports, which detail $2.3 million in Medicare overpayments to three different hospital organizations.
The OIG audited Southcoast Hospitals Group, a three-hospital system based in New Bedford, Mass., St. Joseph Regional Health Center in Bryan, Texas, and Tulane Medical Center in New Orleans.
Southcoast will have to refund more than $1.1 million in Medicare reimbursements, the most of any of the three audited organizations. The OIG reviewed Southcoast's inpatient and outpatient claims from 2010 and 2011, finding that the health system had several billing errors. Most the errors came on the inpatient side, including unnecessary medical care and incorrect diagnosis-related group codes. Southcoast executives agreed with most of the OIG's findings and will strengthen its Medicare compliance, but the health system said it intends to appeal the medical necessity requirements for several of the inpatient claims.
The 310-bed St. Joseph Regional will repay the government $638,960. The OIG looked at St. Joseph Regional's claims during 2009 and 2010, finding the hospital did not comply with Medicare on several inpatient and outpatient claims. St. Joseph Regional was also tagged for medically unnecessary care, incorrect DRG codes and incorrectly billing Medicare separately for related discharges and readmission in the same day. Although hospital officials agreed their Medicare billing needed improvement, they disagreed with how much they should refund and plan on seeking a redetermination and appeal. However, the OIG said its findings were valid.
The OIG said Tulane Medical Center, a 354-bed hospital owned by Nashville, Tenn.-based Hospital Corp. of America, should repay $523,928. The agency found erroneous Medicare claims for incorrect DRG codes, medical necessity and incorrectly billed Lupron injections. Tulane Medical Center officials agreed with some of the OIG's findings, but like the other hospitals, it disagreed with the OIG on compliance for medical necessity, as well as the Lupron claims.
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