Texas hospital overbilled Medicare by $10.6M, OIG says

Texas Health Presbyterian Hospital Dallas failed to comply with Medicare billing requirements for 41 of 100 inpatient and outpatient claims reviewed by HHS' Office of Inspector General, according to an OIG report.

According to the OIG, the hospital submitted 27 inpatient rehabilitation claims that either did not meet coverage or documentation requirements and submitted eight inpatient Medicare Part A claims that should have been billed as outpatient or as outpatient with observation. Six claims submitted by the hospital were incorrectly coded, according to the OIG.

The 41 claims that did not comply with Medicare billing requirements resulted in Texas Health Presbyterian Dallas receiving $500,323 in combined overpayments during the audit period of Jan. 1, 2016, through Dec. 31, 2017, according to the OIG.

Extrapolating from the sample results, the OIG estimated Texas Health Presbyterian Dallas received $10.7 million in overpayments from Medicare during the audit period. During the course of the audit, the hospital submitted 13 claims for reprocessing. As a result, the OIG reduced the estimated overpayments to $10.6 million.

Based on its findings, the OIG recommended the hospital refund Medicare $10.6 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 draft report, Texas Health Presbyterian Dallas disagreed with several of the OIG's findings, including most of those regarding the inpatient rehabilitation claims. The hospital also disagreed with the OIG's use of extrapolation and its recommendation that the hospital refund the extrapolated overpayment.

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

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