OIG: Philadelphia hospital received $538K in Medicare overpayments

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Medicare overpaid the Hospital of the University of Pennsylvania $538,000 for calendar years 2008 through 2011 due to billing noncompliance, according to an Office of Inspector General audit.

The OIG looked at 208 inpatient and outpatient claims and found the 784-bed teaching hospital in Philadelphia failed to comply with Medicare billing requirements for 54 claims.

Of those 54, 30 incorrectly billed inpatient claims led to net overpayments of $279,041 while 24 incorrectly billed outpatient claims resulted in net overpayments of $258,835.

These overpayments occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors, OIG noted in the report summary.

The hospital blamed human error for billing Medicare for incorrect DRG codes, according to the report, and said that because its hospital utilization review staff used inappropriate criteria it incorrectly billed some outpatient services as inpatient.

The hospital also filed adjusted Medicare claims for all 54 claims identified and took corrective action, including conducting a special education session for the coding staff as well as extra training sessions for clinical resource coordinators on the selection and use of criteria to determine the correct level of care.

Meanwhile, the OIG might not be able to conduct such investigations and audits thanks to recent budget cuts, FierceHealthcare previously reported. The OIG said the cutbacks could lead to a "potentially high-risk hospital not being reviewed" and "potentially erroneous claims not being reviewed."

For more:
- here's the OIG summary and report (.pdf)

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