The 123 claims — 56 inpatient and 67 outpatient — that did not comply with Medicare billing requirements resulted in the hospital receiving $819,803 in overpayments.
Extrapolating from the sample results, the OIG estimated NewYork-Presbyterian received at least $14.2 million in overpayments from Medicare during the audit period.
NewYork-Presbyterian disagreed with most of the OIG’s findings. However, the hospital agreed it incorrectly billed 16 inpatient claims and 16 outpatient claims. The net overpayment amount for those claims was $143,920.
After reviewing the hospital’s comments, the OIG maintained its findings.
Based on its findings, the OIG recommended the hospital return net overpayments to the Medicare contractor and strengthen controls to ensure full compliance with Medicare requirements.
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