Sarasota (Fla.) Memorial Health Care System is planning to appeal the HHS Office of Inspector General’s finding that its flagship hospital received at least $12.1 million in Medicare overpayments, a system spokesperson told Becker’s on Feb. 27.
The OIG audited 100 inpatient and outpatient claims from Jan. 1, 2020, through Dec. 31, 2021, at Sarasota Memorial Hospital, according to a report released Feb. 26. The office found that the hospital complied with Medicare billing requirements for 74 of the claims that were reviewed. The hospital was not fully compliant with the other 26 claims, however, resulting in alleged net overpayments of $272,364.
Eleven of the errors were incorrectly billed inpatient claims ($100,746), eight were incorrectly billed inpatient rehabilitation facility claims ($171,148) and seven were incorrectly billed outpatient claims ($470), according to the report.
On the basis of its sample results, the OIG estimated the Sarasota Memorial received net overpayment of at least $12.1 million over the audit period.
“These errors occurred primarily because the hospital did not always follow its written policies and procedures to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors,” the report said.
The office said the audit is part of a series examining hospitals with a high volume of claims previously identified as high-risk for noncompliance. Sarasota Memorial was selected because it submitted a “substantial number of potentially high-risk claims to Medicare.”
“We recommend that the hospital refund to the federal government the $12.1 million in estimated net overpayments, consider conducting internal audits for claims after our audit period based on the risks identified by this audit, and provide additional training regarding Medicare billing requirements,” the OIG said in the report.
A spokesperson for the health system said Sarasota Memorial and outside consultants have received the medical reports and the OIG’s audit in detail and “strongly disagree with its findings.”
“We will appeal this action and are confident that the findings will be reversed by independent adjudicators,” the spokesperson said. “SMH has a long track record of providing quality care to our community and remains committed to meeting or exceeding all Medicare requirements.”
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