Medicare Overpays 50 Teaching Hospitals for Double-Counted Residents

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Fifty teachings hospitals received nearly $2 million in Medicare overpayments for medical residents who were claimed by more than one hospital at the same time, according to a report from the Office of Inspector General.

Highmark Medicare Services is a CMS contractor for district 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and the District of Columbia. An OIG review found 50 teaching hospitals in that district received excess reimbursement for graduate medical education. Some residents were spending time at more than one hospital during the same time, making them double-counted.  

This error occurred because there was no federal requirement for Highmark to review data in the Intern and Resident Information System, a software application hospitals use to collect and report information on residents.

The OIG has recommended Highmark recover the Medicare overpayments, which the contractor agreed to. It did not agree to changing its procedures, however, or expanding review efforts unless CMS issues a contract modification or technical direction letter. It also agreed with the OIG's recommendation that it review IRIS data, since there is no federal requirement or funding to do so.  

Related Articles on Hospitals and Medicare Overpayments:

OIG Identifies Medicare Overpayments to 2 California Hospitals
Boston Medical Center to Refund $90K in Medicare Overpayments
OIG: Cleveland Clinic Received Nearly $254k in Medicare Overpayments


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