After an audit of Baptist Medical Center South in Montgomery, Ala., showed billing errors in its Medicare claims, the HHS Office of Inspector General said the 454-bed hospital must refund $1.78 million to the federal government.
The OIG looked at sample inpatient and outpatient claims at Baptist during 2009 and 2010. The agency said the hospital received net overpayments totaling $242,514. After stratifying that sample size, the OIG estimated Baptist overbilled Medicare at least $1.78 million over those two years.
Baptist officials agreed that its Medicare billing was flawed, but they "disagreed with [the OIG's] extrapolating the sample results." They said the OIG had not previously extrapolated overpayments in other compliance audits and that the hospital "lacked notice" on what the OIG was doing.
Despite Baptist's complaint, the OIG stood its ground, saying the "statistical sampling and estimation techniques…are statistically valid methodologies that we have used successfully to identify overpayments" even though they have not been commonly used in other audits.
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