Billing errors resulted in $23.6M in overpayments to HCA hospital, inspector general finds

Las Vegas-based Sunrise Hospital and Medical Center, owned by Nashville, Tenn.-based HCA Healthcare, failed to comply with Medicare billing requirements for 54 of 100 inpatient and outpatient claims reviewed by the HHS Office of Inspector General, according to an inspector general's report released March 31.

The billing errors, 50 of which were in inpatient claims and four of which were in outpatient claims, resulted in overpayments of $999,950 for the audit period of January 2017 to December 2018, according to the report.

Based on review of the 100-claim sample, the report estimates that the Las Vegas hospital received overpayments of at least $23.6 million.  

The inspector general outlined several recommendations to correct the errors, including that the hospital refund Medicare $23.6 million, identify and return any additional overpayments and improve controls to ensure full compliance with Medicare billing requirements. 

In written comments to the inspector general, the hospital disagreed with most of the inspector general's findings and recommendations. After reviewing the hospital’s comments, the inspector general maintained the findings.

"We strongly disagree with the OIG's audit findings related to our IRF and because we believe the care we provided to our patients was necessary and effective, we will appeal those findings in due course," Todd Sklamberg, CEO of Sunrise Hospital and Medical Center, said in a statement. "We think it unfortunate that the OIG audit process did not take into account the overwhelmingly positive outcomes and the feedback of our patients and their families, all of whom benefited from our IRF services."

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