Several hospitals and health systems across the U.S. were tagged by HHS' Office of the Inspector General for various billing errors this year.
Below is a breakdown of seven of them:
1. Midland (Texas) Memorial Hospital agreed to pay $555,141 to resolve allegations that it improperly submitted claims to the COVID-19 uninsured program. The inspector general alleged that Midland Memorial presented reimbursement claims for testing, treatment and vaccine administration to the program for services rendered to patients without a COVID-19 primary diagnosis or pregnancy with COVID-19 as a secondary diagnosis. The Texas hospital said a coding error was behind the billing errors. After noticing it had improperly submitted claims to the COVID-19 uninsured program, the hospital said it self-disclosed the conduct to the office and agreed to pay the penalty.
2. Jewish Hospital, an 820-bed facility in Louisville, Ky., reportedly failed to comply with Medicare billing requirements for 38 of 100 inpatient and outpatient claims reviewed, the OIG found in an audit released Aug. 18. The billing errors allegedly resulted in overpayments of $705,976 for the period reviewed. Based on results of the 100-claim sample, the OIG estimated that Jewish Hospital was overpaid $13.5 million during the audit period of 2017 to 2018. The OIG provided several recommendations to the hospital, including that it should refund Medicare $13.5 million, report and return any additional overpayments, and strengthen its policies to ensure compliance with Medicare's billing requirements. In written comments to the OIG's draft report, the hospital disputed almost all of the OIG's findings except for billing errors identified in three outpatient claims. After reviewing the hospital's objections and comments, the OIG maintained its findings and recommendations.
3. Norfolk, Va.-based Sentara Healthcare agreed to pay more than $4.3 million to settle allegations that it submitted improper claims in violation of the Civil Monetary Penalties Law. The OIG claimed that Sentara submitted or caused the submission of improper claims related to observation services provided to patients discharged from the system's emergency departments. The OIG alleged that the claims were improper because they didn't have enough support to denote medical necessity or because there was no physician order for the observation services provided. The conduct was self-reported to the OIG.
4. Staten Island University Hospital, a 668-bed hospital in Northwell Health's network, reportedly received $11.8 million in overpayments because of billing errors, according to an OIG report released in June. In particular, the hospital allegedly failed to comply with Medicare billing requirements for 37 of 100 inpatient and outpatient claims reviewed by the OIG. The billing errors resulted in the New York City hospital receiving $830,291 during the audit period of 2016 and 2017. Based on the review of the 100-claim sample, the OIG estimated that Staten Island University Hospital received $11.8 million in overpayments. Although the hospital said it believed it fully complied in 35 of the 37 errors flagged by the OIG, the office maintained its findings and said the hospital should refund the $11.8 million, identify and return any additional overpayments, and strengthen its policies and procedures to ensure compliance with Medicare billing requirements.
5. Camden, N.J.-based Virtua Our Lady of Lourdes Hospital allegedly failed to comply with Medicare billing requirements for 40 of 100 inpatient and outpatient claims reviewed by the OIG, according to an audit report released May 4. The billing errors resulted in the hospital receiving $666,021 in overpayments during the audit period of Jan. 1, 2016, through Dec. 31, 2017, according to the OIG. Based on review of the 100-claim sample, the OIG estimates that Virtua Our Lady of Lourdes received overpayments of at least $4.8 million for the audit period. The OIG provided several recommendations to the hospital, including that it should refund Medicare $4.8 million, identify and return any additional overpayments and strengthen its policies and procedures to ensure compliance with Medicare billing requirements. In comments attached to the draft report, the hospital disagreed with the OIG's findings and recommendations. Despite the hospital's objections, the OIG maintained its findings and recommendations
6. Las Vegas-based Sunrise Hospital and Medical Center, owned by Nashville, Tenn.-based HCA Healthcare, reportedly failed to comply with Medicare billing requirements for 54 of 100 inpatient and outpatient claims reviewed by the OIG, according to a March 31 report. The billing errors resulted in overpayments of $999,950 for the audit period of January 2017 to December 2018, according to the report. Based on the 100-claim sample, the OIG estimates that the Las Vegas hospital received overpayments of at least $23.6 million. The OIG outlined several recommendations to correct the errors, including that the hospital should refund Medicare $23.6 million, identify and return any additional overpayments and improve controls to ensure full compliance with Medicare billing requirements. In written comments to the inspector general, the hospital disagreed with most of the office's findings and recommendations. After reviewing the hospital’s comments, the OIG maintained the findings.
7. Because of billing errors, Tupelo-based North Mississippi Medical Center overbilled Medicare by $67,000, according to an OIG report released in March. The OIG found that the hospital failed to comply with Medicare billing requirements for 12 of 100 claims. The billing errors resulted in the hospital receiving $7,624 in overpayments during the audit period of Jan. 1, 2017, through Dec. 31, 2018, according to the report. Based on a review of the 100-claim sample, the report estimated that North Mississippi Medical Center received overpayments of at least $67,038 for the audit period. The hospital said the errors occurred because of a misunderstanding of Medicare policy.