Several hospitals and health systems across the U.S. were tagged by the HHS Office of the Inspector General for billing errors this year.
Below are eight:
1. St. Joseph's Hospital Health Center, a 451-bed hospital in Syracuse, N.Y., failed to comply with Medicare billing requirements for six of the 100 inpatient and outpatient claims reviewed by the inspector general. The billing errors outlined in an audit released Dec. 16 resulted in overpayments of $68,897. Based on the results of the 100-claims sample, the inspector general estimated that St. Joseph's Hospital was overpaid at least $389,000 for the review period. In written comments to the inspector general's draft report, the hospital partially disagreed with the recommendation to refund the full $389,000; stated that it had returned additional overpayments; and said it has strong policies to ensure Medicare billing compliance. The hospital also took issue with the inspector general's sampling and estimation methods. After reviewing the hospital's objections and comments, the inspector general maintained its findings and recommendations.
2. 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 blamed a coding error. 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.
3. Jewish Hospital, an 820-bed facility in Louisville, Ky., failed to comply with Medicare billing requirements for 38 of 100 inpatient and outpatient claims reviewed, the inspector general found in an audit released Aug. 18. The billing errors resulted in overpayments of $705,976 for the period reviewed. Based on results of the 100-claim sample, the inspector general estimated that Jewish Hospital was overpaid $13.5 million during the audit period of 2017 to 2018. The office provided several recommendations to the hospital, including that it 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 responding to the inspector general's draft report, the hospital disputed almost all of the findings except for billing errors identified in three outpatient claims. After reviewing the hospital's objections and comments, the inspector general maintained its findings and recommendations.
4. 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 inspector general claimed that Sentara submitted or caused the submission of improper claims related to observation services provided for patients discharged from the system's emergency departments. The inspector general 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 inspector general.
5. Staten Island University Hospital, a 668-bed hospital in Northwell Health's network, received $11.8 million in overpayments because of billing errors, according to an inspector general report released in June. The hospital failed to comply with Medicare billing requirements for 37 of 100 inpatient and outpatient claims reviewed by the inspector general. 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 inspector general 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, 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.
6. Camden, N.J.-based Virtua Our Lady of Lourdes Hospital failed to comply with Medicare billing requirements for 40 of 100 inpatient and outpatient claims reviewed by the inspector general, 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 inspector general. Based on review of the 100-claim sample, the inspector general estimates that Virtua Our Lady of Lourdes received overpayments of at least $4.8 million for the audit period. The inspector general offered several recommendations to the hospital, including that it 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 findings and recommendations. Despite the hospital's objections, the inspector general maintained its findings and recommendations
7. Las Vegas-based Sunrise Hospital and Medical Center, owned by Nashville, Tenn.-based HCA Healthcare, failed to comply with Medicare billing requirements for 54 of 100 inpatient and outpatient claims reviewed by the inspector general, 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 inspector general estimated that the Las Vegas hospital received overpayments of at least $23.6 million. The inspector general outlined several recommendations to correct the errors, including that the hospital 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 inspector general maintained its findings.
8. Tupelo-based North Mississippi Medical Center overbilled Medicare by $67,000, according to an inspector general report released in March. The inspector general 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.