Lexington-based University of Kentucky HealthCare failed to comply with Medicare billing requirements for 78 of 232 inpatient and outpatient claims reviewed by HHS' Office of Inspector General during the audit period of 2011 and 2012, according to a recent OIG audit report.
Here are four findings from the report.
1. The 78 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $208,504 in overpayments, according to the OIG. These overpayment amounts include some claims outside of the 3-year recovery period.
2. Based on its findings, the OIG recommended the hospital refund the Medicare contractor $113,441, consisting of $108,796 in overpayments for the incorrectly billed inpatient claims and $4,645 in overpayments for the incorrectly billed outpatient claims that are within the 3-year recovery period. The OIG also recommended that the hospital work with the contractor to return overpayments outside of the 3-year recovery period in accordance with the 60-day repayment rule, and strengthen its controls to ensure full compliance with Medicare requirements.
3. University of Kentucky HealthCare disagreed with the OIG finding that claims were incorrectly billed as inpatient. The hospital maintained that the inpatient admissions were appropriate and met medical necessity as evidenced by the medical record and guidance from the physician advisor, according to the OIG. The hospital also indicated that it would exercise the right to appeal any claims that are eventually denied.
4. After reviewing the hospital's comments on the findings, the OIG maintained its findings and recommendations.
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