OIG tags North Carolina hospital for incorrect billing

North Carolina Baptist Hospital in Winston-Salem failed to comply with Medicare billing requirements for 37 of 246 inpatient and outpatient claims reviewed by HHS' Office of Inspector General for the audit period of Jan. 1, 2013, through Aug. 31, 2014, according to a recent OIG report.

The 37 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $221,481 in overpayments, according to the OIG. Extrapolating from the sample results, the OIG estimated North Carolina Baptist received at least $1.49 million in overpayments from Medicare during the audit period.

Based on its findings, the OIG recommended the hospital refund the Medicare contractor $1.49 million in estimated overpayments and exercise reasonable diligence to identify and return any additional overpayments received outside of the OIG's audit period. The OIG also recommended the hospital strengthen controls to ensure full compliance with Medicare requirements. 

In written comments, North Carolina Baptist disagreed with the OIG's disallowance determinations on certain claims and said it intends to appeal proposed denials for those claims. The hospital also argued the sample results should not be extrapolated. 

After reviewing North Carolina Baptist's comments, the OIG maintained its findings and recommendations.

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