The University of Miami Hospital will have to repay more than $3.7 million to the federal government after a compliance review from the HHS Office of Inspector General found the hospital incorrectly billed Medicare on multiple inpatient claims.
The University of Miami Hospital is the 560-bed flagship of the University of Miami Health System. The OIG reviewed a random sample of 200 Medicare inpatient claims at the hospital from April 2009 through December 2010.
Regulators found 68 of the 200 claims had errors, resulting in $524,009 in overpayments. Most of the errors involved incorrectly billing a stay as inpatient when it should have been outpatient or observation. Other errors included billing Medicare separately for related discharges and readmissions within the same day and using the wrong diagnosis-related group codes.
The OIG stratified its sample results and determined total overpayments during that period resulted in more than $3.7 million, which the University of Miami Hospital must refund.
Hospital officials disagreed with several portions of the OIG's review. They said some of the inpatient claims were not improperly billed, and officials also did not agree with the OIG's decision to extrapolate the results. In addition, University of Miami Hospital executives said they should be able to rebill Medicare Part B for some of the services that should have been billed as outpatient.
OIG analysts maintained their position on all fronts and said the hospital must repay the estimated overpayments to Medicare. If the hospital wants to try to rebill for some services, officials will have to contact their Medicare administrative contractor for further instructions since rebilling falls out of the OIG's purview, according to the report.
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