Hospital cites misunderstanding in $420K Medicare billing errors

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A hospital's billing errors resulted in $420,000-worth of Medicare overpayments in a fourth of its claims over two years, according to an Office of Inspector General (OIG) report released this week. OIG found that errors were due to Missouri's St. John's Hospital failing to adequately control its billing and not fully understanding billing requirements.

"We are continually evaluating and improving our processes to comply with these complex billing regulations," St. John's spokeswoman Cora Scott said in a Springfield News-Leader article. "When billing discrepancies are discovered, we are dedicated to correcting those errors and improving our internal processes going forward."

Medicare paid St. John's $308 million for 31,066 inpatient and 216,433 outpatient claims during calendar years 2008 and 2009, according to the report. Although St. John's complied with Medicare billing requirements for 166 of the 224 claims OIG reviewed, 58 claims had errors that resulted in overpayments of $420,410 from 2008 through 2010, according to the report. Broken down, that's $227,239 in overpayments for 36 incorrect inpatient claims and $193,171 for 22 outpatient claims.

Scott, who said that St. John's isn't under OIG investigation, attributed the errors to complex billing rules.

"The audit determined that billing codes submitted should have been coded and billed differently," she said. "The audit did not find that the services were not provided or were inappropriate."

For example, the hospital overbilled for inpatient claims with short stays when they should have been billed for outpatient or outpatient with observation services.

OIG recommended that St. John's refund Medicare the full 420 grand and strengthen controls for Medicare billing.

In other news, OIG updated its list of top 10 most-wanted healthcare fraud fugitives yesterday.

For more information:
- read the OIG report
- read the Springfield News-Leader article
- check out the OIG Most Wanted list

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