HHS flags $389K in Medicare billing errors at 451-bed New York hospital

St. Joseph's Hospital Health Center, a 451-bed hospital located in Syracuse, N.Y.,  failed to comply with Medicare billing requirements for several claims reviewed by HHS' Office of Inspector General, resulting in $389,000 in U.S. overpayments, according to a recent audit report

The hospital failed to comply with Medicare billing requirements for six of the 100 inpatient and outpatient claims reviewed, the office found. The billing errors resulted in overpayments of $68,897 for the audit period of July 1, 2017 through June 30, 2019. Based on the results of the 100-claims sample, the inspector general estimated that St. Joseph's Hospital was overpaid at least $389,000 for the review period, according to the report released Dec. 16. 

The inspector general's office made several recommendations to the hospital, including that it refund Medicare $389,000, report and return any additional overpayments and strengthen its internal policies to ensure compliance with Medicare's billing requirements. 

In written comments to the inspector general's draft report, the hospital partially disagreed with the recommendation to refund the full $389,000; stated that it had returned additional overpayments; and said it has strong policies to ensure Medicare billing compliance. The hospital also took issue with the inspector general's sampling and estimation methods. 

After reviewing the hospital's objections and comments, the inspector general maintained its findings and recommendations.

"We carefully considered the hospital’s comments on our sampling and estimation methods, and we maintain that our statistical approach resulted in a statistically valid and reasonably conservative estimate of the amount overpaid by Medicare to the hospital," the office said. 

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