Northwestern Memorial Hospital in Chicago received at least $6.4 million in overpayments from Medicare for calendar years 2011 and 2012, according to a recent audit from HHS' Office of Inspector General.
The OIG's $6.4 million-estimation was based on the results of a sample of 171 reviewed claims.
The audit covered $48.6 million in Medicare payments to the hospital for 7,506 claims that were potentially at risk for billing errors. The OIG then selected 171 claims, with payments totaling $1.4 million, as a random sample for review. Of the 171 inpatient and outpatient claims, 85 of the claims did not fully comply with Medicare's billing requirements, resulting in net overpayments of $272,000.
Based on sample results, the OIG estimated that the hospital received at least $6.4 million in overpayments for the audit period.
The OIG recommended Northwestern Memorial Hospital refund the $6.4 millionin estimated overpayments to the Medicare contractor and strengthen controls to ensure full billing requirement compliance.
The hospital partially disagreed with the first recommendation and discussed steps it had taken or planned to take in regard to the second.
The OIG maintained its recommendations.
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