Brigham and Women's overbilled Medicare $1.5M

Boston's Brigham and Women's Hospital received a million and half dollars in overpayments because the hospital didn't fully understand Medicare billing requirements, the Office of Inspector General (OIG) said in last week's audit report. Although Brigham and Women's did comply with Medicare billing requirements for 140 of the 359 claims OIG reviewed from 2009 and 2010, the hospital didn't fully comply with the remaining 219 erroneous claims that racked up to $1.5 million in overpayments.

OIG found that Brigham and Women's didn't have adequate controls to prevent incorrect billing and recommended it refund Medicare the $1.5 million for the 193 incorrect inpatient claims and the 26 incorrect outpatient claims.

The 793-bed teaching affiliate of Harvard Medical School generally concurred with OIG's findings except for five inpatient short stay claims that the hospital insists were appropriate.

"We stress that BWH is strongly committed to compliance," Brigham and Women's Hospital Chief Compliance Officer James Bryant wrote in a letter to OIG. "We dedicate substantial resources and staff to preventing, detecting and correcting any errors that are identified. We are committed to implementing even stronger internal controls and monitoring to minimize the risk of error going forward."

Brigham and Women's Hospital isn't alone in recent OIG dings for similar reasons. Thomas Jefferson University Hospitals in Philadelphia received $43,000 in overpayments because it incorrectly billed for inpatient same-day readmissions. In four of the 133 same-day readmissions that OIG reviewed, the hospital's case management misinterpreted the readmissions and billed the second admission as a separate inpatient stay instead of a continuous stay.

Similarly, St. Vincent's Medical Center in Bridgeport, Conn., didn't fully understand Medicare billing requirements for 41 claims out of the 198 reviewed, resulting in $284,773 in overpayments in 2009 and 2010, the OIG found.

During the first quarter of fiscal 2012 (October through December 2011), RACs have collected $397.8 million in overpayments--the largest amount recovered during one quarter since the RAC program started.

For more information:
- check out the OIG report (.pdf)

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