The 11 inpatient claims and three outpatient claims that had billing errors resulted in the hospital receiving $204,265 in overpayments during the audit period of Jan. 1, 2016, through Dec. 31, 2017, according to the OIG.
Extrapolating from the sample results, the OIG estimated St. Francis Hospital received $1.6 million in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended the hospital refund Medicare $1.6 million in estimated overpayments, exercise reasonable diligence to identify and return any additional overpayments and strengthen controls to ensure full compliance with Medicare requirements.
In written comments on the draft report, the hospital disagreed with most of the OIG’s findings and recommendations, including the OIG’s extrapolation methodology. The hospital agreed with six of the 14 billing errors identified in the sample.
After reviewing the hospital’s comments, the OIG maintained its findings and recommendations.
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