A coding error was the reason Midland (Texas) Memorial Hospital paid $555,141 to resolve improper claims allegations made by the HHS Office of the Inspector General, hospital leaders told local television station KWES-TV Sept. 16.
After noticing it had improperly submitted claims to the COVID-19 uninsured program, the hospital said it self-disclosed the conduct to the office and agreed to pay the $555,141.
The inspector general alleged that Midland Memorial presented reimbursement claims for testing, treatment and vaccine administration to the program for services rendered to patients without a COVID-19 primary diagnosis, or pregnancy with COVID-19 as a secondary diagnosis. The alleged misconduct would be a violation of the Civil Monetary Penalties Law.
The hospital said it miscoded 87 uninsured patients that never had COVID-19, resulting in more reimbursement from the HHS Health Resources and Services Administration.
The sequencing of coding is different for insured and uninsured COVID-19 patients, according to Midland Memorial CEO Russell Meyers. Samuel Moore, the CFO, agreed, saying "the way that HRSA wanted us to code COVID-positive self-paid patients was different than what we would've done for anyone else."
The coding team typically lists another condition before COVID-19, but the resources and services administration requires them to list COVID-19 first. Hospital leaders said this caused the coding to get misrecorded.
The hospital asked its third-party billing auditor to review all of its COVID-19 claims a few months after it discovered the error. Hospital leaders said the review process continues.