OIG audit: Mount Sinai overbilled Medicare by nearly $42M

Mount Sinai
The federal government is calling on Mount Sinai Hospital to repay $42 million in Medicare payments. Wikimedia Commons/Workhorse.investor

A federal audit found that Mount Sinai Hospital in New York overbilled Medicare by nearly $42 million, but the hospital is pushing back against findings.

The Department of Health and Human Services Office of Inspector General’s audit included more than 6,300 claims filed between Jan. 1, 2012 and Dec. 31, 2013, with a payout of more than $74 million. The OIG examined a random sample of 261 claims from that group and found that in 151 cases the hospital complied with Medicare reporting requirements.

However, it found billing errors in 110 cases, which resulted in more than $1.3 million in payments. Based on the sample, the OIG estimated Mount Sinai owes the government more than $41.8 million.

“These errors 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,” the OIG added in its report (PDF).

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The OIG said that Mount Sinai should take steps to identify other instances of overpayment that fell outside of the audit window, and repay those as well. It also recommends that the hospital shore up its compliance program.

Mount Sinai, however, wrote in a response letter that it is too late for the feds to claim the vast majority of those payments, as they fall outside of the recovery deadline. In addition, the hospital’s Chief Risk Officer Frank Cino wrote in the letter that some of the claims fell outside the four-year reopening window and did not need to be returned.

The hospital “prides itself on having a strong culture of compliance,” he added, and it works to “constantly re-evaluate and continually improve its programs to make them best in case.”

The hospital did concede on four inpatient claims and 21 outpatient claims, which totaled more than $219,000 in payments. It said it would repay those that fell within in the claims period. Mount Sinai indicated in its letter that it would strongly defend itself in court on the other claims.

Despite Mount Sinai’s response, the OIG is standing by its findings, according to its report. The audit was part of a series of hospital compliance reviews.