Mobile (Ala.) Infirmary Medical Center failed to comply with Medicare billing requirements for 13 of 100 inpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report.
The 13 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $163,104 in combined overpayments during the audit period of Jan. 1, 2015, through Dec. 31, 2016, according to the OIG.
Extrapolating from the sample results, the OIG estimated Mobile Infirmary Medical Center received at least $340,125 in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended the hospital refund Medicare $340,125, exercise reasonable diligence to identify and return any additional overpayments received outside of the audit period, and strengthen controls to ensure full compliance with Medicare requirements.
In written comments on the draft report, Mobile Infirmary Medical Center said it correctly billed inpatient rehabilitation claims that the OIG identified as not fully complying with Medicare billing requirements. The hospital also stated that the medical review contractor failed to properly identify and analyze documentation that rebutted the medical review findings. In addition, the hospital said its legal and medical experts noted patterns of misapplication of inpatient rehabilitation facility regulations that led to four mistaken error categories.
Based on the hospital's rebuttal and the OIG's internal review, the OIG reduced the overpayment amount and associated recommendation in the draft report to $340,125 in the final report.
Mobile Infirmary Medical Center will have the opportunity to appeal the results of the audit.
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