The HHS Office of Inspector General has issued a report, finding St. Vincent's HealthCare in Jacksonville, Fla., received approximately $3.3 million in estimated Medicare overpayments, but the health system disagreed with the OIG's findings.
The OIG chose 207 sample hospital claims from a total of 4,087 that were "potentially at risk for billing errors." The claims were from 2009 and 2010.
According to the report, St. Vincent's HealthCare did not comply with Medicare billing requirements for 52 inpatient claims, which led to $282,217 in overpayments. The most common billing errors, as has been the case with most OIG audits, were medical necessity and the hospital billing for Medicare Part A when the services should have been billed as outpatient or observation.
The agency then stratified results from the sample, saying the system received about $3.3 million in Medicare overpayments in 2009 and 2010.
The case is similar to one involving JFK Medical Center in Atlantis, Fla. There, the OIG found the hospital received $4.4 million in incorrect Medicare payments, based on a similar stratified sample.
Attorneys with Dentons, a global law firm representing St. Vincent's HealthCare that also represented JFK Medical Center, said St. Vincent's HealthCare should not have to repay any claims paid in 2009 because they fall outside the statute of limitations. Attorneys made the same case for JFK Medical Center. St. Vincent's HealthCare also did not agree with the OIG's statistical sampling, saying it could lead to repaying Medicare twice if recovery auditors, or RACs, go after the same claims at a different time.
The OIG said after obtaining an independent review of its findings, it stood by its report. It expects St. Vincent's HealthCare to refund the $3.3 million. However, the OIG said the system can tell CMS which claims in the OIG's sample went under previous RAC review, and CMS could reduce the refund as appropriate.
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