OIG tags 612-bed Georgia hospital for erroneous billing

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Savannah, Ga.-based Memorial University Medical Center, which was recently acquired by Nashville, Tenn.-based HCA Healthcare, failed to comply with Medicare billing requirements for 39 of 131 inpatient and outpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report.

The 39 claims that did not comply with Medicare billing requirements resulted in the 612-bed hospital receiving $599,530 in combined overpayments during 2015 and 2016, according to the OIG.

Extrapolating from the sample results, the OIG estimated MUMC received at least $1.4 million in overpayments from Medicare during the audit period.

After subtracting claims the hospital correctly reprocessed during the audit period, the OIG recommended the hospital refund Medicare just over $1.3 million. The OIG also recommended the hospital exercise reasonable diligence to identify and return any additional overpayments received outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements.

In written comments on the draft report, MUMC disagreed with 17 of the 39 claim errors the OIG identified. The hospital said the inpatient rehabilitation facility claims were not audited by the OIG, but were instead audited by an independent medical reviewer who did not allow the hospital to submit additional documentation that would show the 17 claims met medical necessity requirements for the services provided. MUMC said it would pursue the Medicare appeals process for these claims.

After reviewing MUMC's written comments, the OIG maintained its findings and recommendations. The OIG said independent medical reviewers were provided all documentation necessary to determine medical necessity for the inpatient rehabilitation facility claims.

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