A new report from the HHS Office of Inspector General found JFK Medical Center in Atlantis, Fla., incorrectly billed Medicare by almost $4.4 million and must pay back that sum to the government.
JFK Medical Center is a 460-bed teaching hospital and part of Nashville, Tenn.-based Hospital Corporation of America. The OIG selected 200 sample hospital claims from a total of 3,816 that were "potentially at risk for billing errors." The claims were from 2009 and 2010.
The OIG found JFK Medical Center did not comply with Medicare billing guidelines for 70 inpatient claims, which led to $293,869 in overpayments. The most common billing errors were medical necessity — or the hospital billing for Medicare Part A when the services should have been billed as outpatient or observation. The agency then estimated the hospital received $4.4 million in Medicare overpayments in 2009 and 2010 based on the sample results.
Attorneys with Dentons, a global law firm representing HCA and JFK Medical Center, refuted the OIG's findings. They said the hospital should not have to repay any claims paid in 2009 because they fall outside the statute of limitations. According to federal law, the government cannot recoup any Medicare funds after three years, making the last day to recover an overpayment for those claims Dec. 31, 2012. Officials also did not agree with the OIG's medical necessity determinations, nor its extrapolation from the sample size.
However, the OIG stood by its report. The agency said it is not alleging JFK Medical Center "engaged in fraud." However, officials said the incorrect claims establish "similar fault" under Medicare compliance, meaning there is no time limit on reopening claims. In addition, the OIG received an independent, third-party review of all claims in question, finding its analysis and extrapolations were valid. The OIG fully expects JFK Medical Center to refund the $4.4 million.
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