OIG tags North Carolina hospital for incorrect billing

HHS' Office of Inspector General found Vidant Medical Center in Greenville, N.C., submitted erroneous bills to Medicare for treatment of severe malnutrition.

For the audit period of Jan. 1, 2013, through June 30, 2015, the OIG said Vidant Medical Center submitted 89 claims to Medicare that used the codes for nutritional marasmus or other severe protein-calorie malnutrition when a different malnutrition code or no malnutrition code should have been used. This resulted in overpayments of $401,971.

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

Based on its findings, the OIG recommended Vidant Medical Center refund the Medicare contractor $1.4 million, exercise reasonable diligence to identify and return any additional overpayments outside of the audit period and strengthen controls to ensure full compliance with Medicare requirements. 

In written comments, the hospital agreed that 11 of the 89 claims identified by the OIG contained billing errors. However, the hospital did not agree with the OIG's determination regarding the remaining 78 claims. The hospital maintained that its coding and compliance programs provide adequate controls to ensure compliance with Medicare billing requirements.

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

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