OIG tags North Carolina hospital for erroneous billing

WakeMed Raleigh (N.C.) Campus failed to comply with Medicare billing requirements for 76 of 263 inpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report.

The 76 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $249,954 in combined overpayments during the audit period of Sept. 1, 2014, through Aug. 31, 2016, according to the OIG.

Extrapolating from the sample results, the OIG estimated WakeMed Raleigh Campus received at least $697,608 in overpayments from Medicare during the audit period.

Based on its findings, the OIG recommended the hospital refund Medicare $697,608, 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, WakeMed Raleigh Campus disagreed with the OIG's findings on certain claims and contended that the extrapolation of the OIG's sample results was not appropriate or justifiable. The hospital said the audit results do not demonstrate deficiencies in its key controls for coding, billing and documenting within medical records.

After reviewing the hospital's written comments, the OIG maintained its findings and recommendations. The OIG said independent medical reviewers determined whether certain sampled claims were appropriately billed, and that it used statistically valid methodology in its sample selection and in determining the estimated Medicare overpayment.

WakeMed Raleigh Campus said it intends to appeal the results of the audit.

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