The 25 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $798,064 in overpayments, according to the OIG. Specifically, 23 inpatient claims had billing errors, resulting in overpayments of $228,969, and two outpatient claims had billing errors, resulting in overpayments of $569,095.
Based on its findings, the OIG recommended the hospital refund the overpayments to the Medicare program and strengthen its controls to ensure full compliance with Medicare requirements.
Sierra View Medical Center disagreed with some of the OIG’s findings. The hospital contended that it did not improperly bill for 20 of the 25 improper claims the OIG identified in its audit.
After receiving the hospital’s comments, the OIG maintained its findings and recommendations.
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