The HHS Office of Inspector General has ordered three hospitals within Irving, Texas-based Christus Health to repay more than $3.3 million in Medicare funds after several audits found billing errors.
Christus Hospital-St. Elizabeth in Beaumont, Texas, Christus Santa Rosa Hospital in San Antonio and Christus St. Frances Cabrini Hospital in Alexandria, La., are the hospitals in question. The OIG looked at stratified samples of Medicare claims at each of the hospitals from January 2010 through June 2012.
Of the 300 sampled inpatient short-stay inpatient claims, the OIG found the hospitals only complied with Medicare billing rules for 84 claims cumulatively. The most prevalent errors cited were medical necessity, as the OIG said many of the claims billed for Medicare Part A when they should've been billed as outpatient or observation.
Christus Hospital-St. Elizabeth is expected to pay back the most — about $1.32 million. Christus Santa Rosa and Christus St. Frances Cabrini will have to return $1.2 million and $814,568, respectively.
However, each of the hospitals and the system disagreed with the OIG's audits. They had the questioned claims reviewed again by "independent physician experts," who said most of the claims deemed noncompliant by the OIG were, in fact, justified. Christus plans to appeal the claims, but the OIG defended its reviews. The government watchdog said it too used an independent party to review the medical records, which concluded the inpatient short stays should've been billed as outpatient.
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