OIG: Medicare overpaid Cleveland Clinic $254K due to poor billing controls

The Cleveland Clinic was overpaid nearly $254,000 for inappropriate Medicare claims, according to an Oct. 24 Office of the Inspector General (OIG) report, released this week.

Although the Clinic disagreed with some the OIG's draft report, the OIG found that the Clinic was overpaid $253,593 for 24 claims ($184,568 outpatient and $69,025 inpatient), and beneficiaries incurred $5,615 in additional copayment costs due to poor billing controls.

The OIG reviewed the Clinic's claims for procedures regarding medical device replacements during 2008 and 2009, such as pacemakers and cardioverter defibrillators. When providers replace these medical devices, as needed, device manufacturers give providers full or partial credit for devices that are under warranty or replaced because of recalls. To offset these credits, Medicare reduces the payment for the device replacement, according to the report.

The OIG found that the Clinic did not fully comply with Medicare requirements for obtaining credits from manufacturers and for reporting appropriate billing codes and charges to reflect that it received the credits.

Cleveland Clinic agreed with the OIG that it needed to strengthen procedures for identifying and obtaining credits from manufacturers and establish reporting procedures in accordance with Medicare rules. It has since implemented new procedures for processing credits from device manufacturers.

For more information:
- read the OIG executive summary
- read the OIG report (.pdf)

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