The HHS Office of Inspector General has ordered Sutter Medical Center, Sacramento (Calif.), the flagship of Sutter Health, to refund $1.04 million in Medicare payments due to incorrectly billed claims.
According to the OIG's audit, Sutter Medical Center, which includes Sutter General Hospital and Sutter Memorial Hospital, had errors on 64 percent of sample inpatient and outpatient claims in 2010 and 2011. A vast majority of the errors came on the inpatient side, specifically for billing Medicare Part A when the hospitals should have billed the claims as outpatient or observation.
The errors resulted in a little more than $1.04 million in Medicare overpayments. The OIG said Sutter must repay the full amount and improve its Medicare billing compliance. In a letter to the OIG, Sutter Medical Center CEO Carrie Owen-Plietz said her organization disagreed with many of the OIG's findings and argued the medical center "was not given an opportunity to discuss and agree upon" the audited cases. Sutter intends to appeal most of the cases.
Despite Sutter's disagreements, the OIG stood by its findings and said it gave the hospitals a chance to discuss the claims in question.
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