Naples (Fla.) Community Hospital failed to comply with Medicare billing requirements for 91 of 225 inpatient claims reviewed by HHS' Office of Inspector General during the audit period of Jan. 1, 2011, through Dec. 31, 2012, according to a recent OIG audit report.
The 91 claims that did not fully comply with Medicare billing requirements resulted in the hospital receiving $409,366 in overpayments, according to the OIG. Using statistical sampling and extrapolation, the OIG estimated the hospital received at least $4.58 million in overpayments from Medicare during the audit period.
Based on its findings, the OIG made the following three recommendations:
1. The hospital should refund the Medicare program $1.51 million in estimated overpayments for the incorrectly billed services that are within the three-year claims recovery period.
2. The hospital should work with the Medicare contractor to return overpayments outside of the three-year recovery period in accordance with the 60-day repayment rule.
3. The hospital should strengthen its controls to ensure full compliance with Medicare requirements.
Naples Community Hospital partially disagreed with the OIG's finding and recommendations. The hospital said it did not improperly bill for 63 of the 91 claims the OIG identified as improper.
After receiving the hospital's comments, the OIG maintained its findings and recommendations.
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