OIG: Mount Sinai Hospital overbilled Medicare by $41.9M

Mount Sinai Hospital in New York City failed to comply with Medicare billing requirements for 110 of 261 inpatient and outpatient claims reviewed by HHS' Office of Inspector General for the audit period of Jan. 1, 2012, through Dec. 31, 2013, according to a recent OIG report.

The 110 claims that did not comply with Medicare billing requirements resulted in the hospital receiving nearly $1.4 million in overpayments, according to the OIG.

Extrapolating from the sample results, the OIG estimated Mount Sinai Hospital received at least $41.9 million in overpayments from Medicare during the audit period.

Based on its findings, the OIG recommended the hospital refund Medicare the portion of the estimated overpayment within the Medicare reopening and recovery periods and use reasonable diligence to identify and return the remaining portion of the overpayment. The OIG also recommended the hospital take steps to return any additional overpayments outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements.

In written comments on the OIG's draft report, Mount Sinai Hospital disagreed with most of the OIG's findings and recommendations. The hospital disagreed that it improperly billed 85 of the 100 claims identified by the OIG. The hospital also said some of the claims fall outside of the Medicare reopening period. 

After reviewing the hospital's comments, the OIG maintained its findings and recommendations.

In an emailed statement to Becker's, Mount Sinai said, "We reject the notion that it's appropriate for OIG auditors to substitute their judgments, made years after the fact without any patient interaction, for the thoughtful medical decisions of our highly skilled physicians. Moreover, the review process used by the OIG is deeply flawed. Not only are their determinations based on erroneous interpretations of the prevailing rules, but their refund demand is based on a review of a tiny sample of claims. In fact, 97 percent of the refund demand relates to claims OIG never even reviewed."

Mount Sinai said it intends to appeal the OIG's findings, and is "highly confident" it will prevail. 

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