Dive Brief:
- The HHS Office of the Inspector General has ordered three hospitals within a Texas-based healthcare chain to repay more than $3.3M in Medicare funds. The three hospitals are part of Irving, Texas-based Christus Health.
- To reach its conclusion, the OIG looked at stratified samples of Medicare claims at each of the hospitals from January 2010 through June 2012. Of 300 sampled inpatient short-stay claims, the OIG found that the hospitals only complied with Medicare billing rules for 84 claims across the three facilities.
- Not surprisingly, each of the hospitals and the Christus system disagreed with the OIG's audits and plan to appeal the demand for repayment.
Dive Insight:
This is going to be a sticky case. While the OIG insists that the Christus Hospitals billed for inpatient stays when they should have billed for outpatient, Christus has a team of "independent physician experts" that reviewed the claims and said that most of them were justified. Of course, the OIG isn't going to take that lying down -- as you can imagine, it stands by its demands. This conflict is likely to drag out for a long time.