Boston Medical Center was overpaid $89,724 after the hospital incorrectly coded and billed for 7,520 claims on behalf of the physicians, the Office of Inspector General (OIG) recently reported.
Boston Medical Center incorrectly documented thousands of claims between 2006 and 2010 by using non-facility place-of-service codes for services that actually were performed in one of the hospital's outpatient facilities. The outpatient setting includes freestanding ambulatory surgical centers, whereas non-facility settings include physician offices, urgent care centers, or independent clinics. When physicians perform services in non-facilities, Medicare reimburses them at a higher rate to accommodate the overhead expenses of non-facility settings. However, auditors found that Boston Medical Center submitted incorrect place-of-service codes.
Hospital officials have insisted on repaying all of the overpayments, while asking the OIG to verify the calculations, the report notes.
OIG also recently reported that Norwood (Mass.) Hospital, under Steward HealthCare System, did not comply with Medicare billing requirements for 99 claims, resulting in overpayments totaling $207,000 from 2008 through 2010; the hospital did not have adequate controls and did not fully understand Medicare billing requirements. Meanwhile, Tallahassee Memorial HealthCare, Inc., was overpaid $130,000 for 14 claims that had billing errors in 2009 and 2010 for similar reasons.
The OIG is charged with protecting the Health & Human Services programs, including Medicare and Medicaid through audits, inspections, and investigations. The agency recovered a total of $797.4 million in overpayments for fiscal year 2011.
For more information:
- read the OIG report on Boston Medical Center
- here's the report on Norwood Hospital
- check out the report on Tallahassee Memorial HealthCare
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