The 69 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $865,243 in overpayments. Extrapolating from the sample results, the OIG estimated Lafayette General received at least $4.4 million in overpayments from Medicare during the audit period. The hospital refunded $287,257 after the start of the OIG’s review, leaving a net overpayment of $4.1 million.
Based on its findings, the OIG recommended the hospital refund the Medicare contractor $4.1 million, ensure the amount already refunded was recovered by Medicare and strengthen controls to ensure full compliance with Medicare requirements.
Lafayette General disagreed with some of the OIG’s findings. The hospital said it incorrectly billed for 18 of the 69 claims flagged by the OIG.
After receiving the hospital’s comments and objections, the OIG maintained its findings and recommendations.
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