Jackson-Madison County General Hospital, a 635-bed hospital in Jackson, Tenn., failed to comply with Medicare billing requirements for 59 of 200 inpatient claims reviewed by HHS' Office of Inspector General for the audit period of June 1, 2013, through May 31, 2015, according to a recent OIG report.
The 59 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $188,988 in overpayments, according to the OIG.
Extrapolating from the sample results, the OIG estimated Jackson-Madison County General Hospital received at least $1.4 million in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended the hospital refund $1.4 million to the Medicare contractor, which CMS contracts with to process and pay claims submitted by hospitals. The OIG also recommended the hospital exercise reasonable diligence to identify and return any additional overpayments outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements.
In written comments, Jackson-Madison County General Hospital agreed that 35 of the 59 claims identified by the OIG contained billing errors. The hospital did not fully agree with the OIG's determination regarding the remaining 24 claims.
After reviewing the hospital's comments, the OIG maintained its findings and recommendations.
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