OIG: U of Miami Hospital must repay $3.7M in Medicare overpayments

The University of Miami Hospital (UMH) overbilled Medicare by more than $3 million from April 1, 2009 through Dec. 31, 2010, according to an Office of Inspector General audit.

The OIG reviewed 200 inpatient claims and found the 560-bed hospital improperly billed Medicare for 68 claims, totaling $538,000 in overpayments during the audit period. The OIG then extrapolated those results across the audit period and estimated UMH received at least $3,717,557 in overpayments, according to the report summary.

Of the reviewed claims, the hospital incorrectly billed 56 inpatient claims that should have been outpatient or outpatient with observation services, thanks in part to a weak review process and case management leadership turnover. Billing office miscommunication led the hospital to separately bill Medicare for three claims for related discharges and readmissions within the same day.

In response to recommendations to strengthen billing controls, the hospital said it will discuss compliance issues in monthly service calls with the billing office and has established a formal work queue for better tracking, monitoring and communication between billing and case management.

However, the hospital disagreed with OIG "treating UMH differently" and extrapolating the results, noting past hospital compliance reports only recommended hospitals repay audited claims. "The lack of clarity regarding the standards for short stays and the controversy over rebilling also argues strongly against extrapolation," UMH Chief Financial Officer Darryl Caulton said in a letter to the OIG.

For more:
- here's the OIG summary and report (.pdf)