The OIG looked at 250 inpatient and outpatient claims the 541-bed Saint Thomas billed during 2009 and 2010. The regulatory agency found several inpatient errors, mostly for services that were rendered in the inpatient setting when they should have been billed as outpatient or observation. The OIG extrapolated its audit findings, concluding that CMS overpaid Saint Thomas $1.09 million during the two-year timeframe.
The OIG recommended Saint Thomas refund the money and strengthen its Medicare billing compliance, but hospital officials disagreed about refunding certain Medicare funds. The hospital said it should not have to refund all money from the claims that were billed as inpatient when they should have been outpatient; instead, they argued the hospital should keep the difference between the inpatient amount received and the correct outpatient amount it would have received.
However, government officials said they did “not have enough information” to calculate those differences in payment and that Saint Thomas refund the full amount.
More Articles on Medicare Overpayments:
Rapid City Regional Hospital Overbilled CMS $257k, OIG Says
OIG: Cedars-Sinai Medical Center Overbilled Medicare $2.24M
North Shore Medical Center Overbilled Medicare $816k
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