OIG: U of Wisconsin overbilled Medicare $316K

The University of Wisconsin (UW) Hospitals and Clinics owes $316,000 in Medicare overpayments on claims between 2008 and 2010, an Office of Inspector General audit found.

While the hospital met billing requirements for 87 out of 186 inpatient and outpatient claims reviewed, the remaining 99 did not comply with Medicare billing requirements, according to the OIG's summary.

In written comments on the draft report, UW disputed the findings for 10 of the inpatient claims, which the OIG report stated should have been billed as outpatient or outpatient with observation services. After review, however, OIG maintained the findings.

The audit found billing errors in 48 outpatient claims and 51 inpatient claims. The OIG's report attributes these errors to inadequate controls to safeguard against billing mistakes. The 566-bed Madison medical center received approximately $573 million in Medicare payments between 2008 and 2010, according to the OIG.

The review found multiple types of billing errors, such as patients being incorrectly billed as inpatient, incorrect discharge status and unreported manufacturer credits for replaced medical devices.

In addition to its recommendation that the hospital refund the Medicare contractor for the overpayments, the OIG also recommended the hospital "strengthen controls to ensure full compliance with Medicare requirements."

UW agreed, and told the OIG it will streamline its compliance, educational and internal audit programs.

"We are committed to complying with all regulations and standards governing Federal health care programs, and embrace opportunities to improve our educational, internal audit and compliance programs to monitor and minimize the risk of non-compliant claims," UW representatives wrote in a statement, which is included in full in the OIG report.

Another OIG audit this week determined the University of Miami Hospital (UMH) similarly overbilled Medicare by more than $3 million between 2009 and 2010. The 560-bed hospital made billing errors for 68 of 200 inpatient claims. UMH, like the University of Wisconsin, responded to the review by resolving to improve tracking, monitoring and communication, FierceHealthcare previously reported.

To learn more:
- read the OIG's summary and full review (.pdf)

Suggested Articles

The Texas Health and Human Services Commission was hit with a $1.6 million fine for violating HIPAA privacy and security rules.

A ransomware attack hitting several computer systems at Brooklyn Hospital Center caused permanent loss of some patients' data.

The University of Rochester Medical Center is paying $3 million to resolve potential HIPAA violations, one of the biggest settlements this year.