UPMC Presbyterian, Shadyside Hospitals Flagged for $796k in Overpayments

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The flagship hospital campuses of University of Pittsburgh Medical Center will have to repay $796,202 in Medicare reimbursement back to the federal government due to erroneous inpatient and outpatient claims, according to a report from the HHS Office of Inspector General.

The OIG audited 239 inpatient and outpatient claims at UPMC Presbyterian and UPMC Shadyside for services provided during 2008 through 2011, finding errors in 114 of those claims. Together, UPMC Presbyterian Shadyside comprises a 1,532-bed, two-campus hospital.

Similar to other OIG audits of hospitals, UPMC's main errors were associated with billing for inpatient when outpatient or observation status should have been used. Other errors included manufacturer credits for replaced medical devices and incorrect DRG codes.

Eileen Simmons, CFO and compliance officer of UPMC Presbyterian Shadyside, wrote to the OIG and generally concurred with the audit's findings. The organization has reprocessed all identified claims and will enhance its Medicare billing compliance.

More Articles on Hospitals and Medicare Overpayments:
Audit of University of Wisconsin Hospital and Clinics Finds $316k in Billing Errors
OIG: University of Miami Hospital Overbilled Medicare $3.7M
OIG Slams 3 Hospitals, Health Systems for $2.3M in Medicare Overpayments

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