Hospitals audited for Medicare overpayments

MedStar Georgetown University Hospital overbilled Medicare for $659,000 because the Washington, D.C., hospital didn't adequately control billing and coding of claims or didn't fully understand billing requirements, according to an Office of Inspector General report released last week.

Although the hospital did comply with 131 out of the 265 inpatient and outpatient claims the OIG audited, it did not comply with Medicare requirements for the remaining 134 claims for calendar years 2009 and 2010, according to the report summary. More specifically, the hospital erroneously billed for 40 outpatient claims worth $24,718 for mistakes related to excess charges, inpatient stays, multiple surgeries and evaluation and management services billed with other services, which Georgetown University Hospital concurred with. However, the OIG found 94 inpatient claims for short stays and excess charges that resulted in Medicare overpayments worth $634,653, which the hospital disagreed with.

The 609-bed acute care teaching hospital told the OIG it anticipates making adjustments for reimbursement under Medicare Part B for services for the short stay inpatient claims and for corrected DRG codes. The hospital also said it would continue training staff on billing accuracy.

"Prior to the OIG's audit, the hospital launched an education campaign and conducted audits to monitor billing accuracy," Georgetown University Hospital Chief Financial Officer Paul Warda wrote in a letter to the inspector general. "The hospital will continue to provide documentation, coding and compliance education to coding and billing staff, attending physicians and residents on an ongoing basis. Further, the hospital will continue to monitor and audit internal controls and remediate identified errors."

Meanwhile, in two other reports last week, OIG audits revealed that outpatient billing errors for selected drugs resulted in Medicare overpayments. In its review of injection drugs (doxorubicin hydrochloride liposome, rituximab, pemetrexed, cetuximab and epoetin alfa), OIG found that O'Connor Hospital in San Jose, Calif., received overpayments of more than $46,000, for which it will repay the Medicare contractor.

Similarly, OIG found in its review of injection drugs (infliximab, rituximab, doxorubicin hydrochloride liposome, bortezomib, pemetrexed, alteplase and epoetin alfa), University of Utah Hospitals and Clinics in Salt Lake City did not bill Medicare in accordance with requirements, resulting in overpayments totaling $77,000. University of Utah attributed the overpayment to clerical and billing errors.

For more information:
- see the OIG summary and report (.pdf) on Georgetown University Hospital
- read the OIG summary and report (.pdf) on O'Connor Hospital
- here's the OIG summary and report (.pdf) on University of Utah Hospitals and Clinics

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Editor's Note: An earlier version of the article did not specify the operator of Georgetown University Hospital. For clarity, FierceHealthcare updated this article with the hospital name.

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