The OIG looked at inpatient and outpatient claims billed during 2010 and 2011 at Heartland Regional, the 328-bed flagship within Mosaic Life Care. Government officials said Heartland Regional’s billing errors were mostly due to medical necessity (billing Medicare Part A for services that should’ve been billed as outpatient or observation), which the OIG attributed to the hospital not having “adequate controls to prevent the incorrect billing.”
Heartland Regional officials mostly agreed with the OIG’s findings, but the hospital disagreed with the agency’s assessment of medical necessity on the reviewed inpatient claims. The OIG stood by its audit and said the hospital must repay the full amount listed.
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38 Hospitals the OIG Tagged for Medicare Overpayments in 2013
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