Pennsylvania hospital overbilled Medicare by $3.3M, inspector general finds

Forbes Hospital in Monroeville, Pa., failed to comply with Medicare billing requirements for 51 of 100 inpatient and outpatient claims reviewed by the HHS Office of Inspector General.

The 51 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $590,646 in combined overpayments during the audit period of Jan. 1, 2016, through Dec. 31, 2017, according to the inspector general's report. 

Extrapolating from the sample results, the report estimated Forbes Hospital received at least $3.3 million in overpayments from Medicare during the audit period. 

Based on its findings, the inspector general recommended that the hospital refund Medicare $3.3 million, 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 report, Forbes Hospital disagreed with its findings and recommendations about incorrectly coded and billed claims. The hospital also disagreed with the inspector general's use of extrapolation. The hospital said it would appeal the findings. 

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

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