The OIG’s $2.49 million-estimation was based on the results of a sample of 251 reviewed claims. Of the 251 inpatient and outpatient claims, 59 of the claims did not fully comply with Medicare’s billing requirements, resulting in about $452,000 in net overpayments.
The audit covered $33.1 million in Medicare payments to the hospital for 2,462 claims that were potentially at risk for billing errors. The OIG then selected 251 claims, with payments totaling $3.5 million, as a random sample for review. Based on sample results, the OIG estimated that the hospital received at least $2.49 million in overpayments for the audit period.
The OIG recommended University of North Carolina Hospitals refund the $2.49 million in estimated overpayments to the Medicare contractor and strengthen controls to ensure full billing requirement compliance.
The hospital agreed that 3 of the 59 claims were billed incorrectly, but disagreed with determinations for the remaining 56 claims.
The OIG maintained its findings based on an independent medical review contractor’s conclusions.
More articles on healthcare finance:
CFO Matt Leary: Juggling responsibilities at Wesley Medical Center
Children’s Hospitals and Clinics of Minnesota opens pediatric pain clinic
How to succeed under risk-based payment models
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.