Dive Brief:
- The HHS Office of Inspector General recently told the University of Cincinnati Medical Center that it must refund $9.8 million in Medicare payments because of alleged inpatient billing errors.
- This arose from a Medicare extrapolation audit based on only 228 claims, after auditors found overpayments of $603,000 for 127 of them. The other 101 claims were OK, auditors said.
- Hospital officials told Modern Healthcare that such a refund would have a devastating financial impact.
Dive Insight:
This latest hefty hospital fine was announced by the HHS OIG June 5. That was three days after the American Hospital Association's letter urging a halt to the HHS OIG's Medicare compliance audits, calling them flawed and redundant to reviews undertaken by Medicare Recovery Audit Contractors.
The hospital industry is crying foul over such audits, while CMS and watchdog groups insist that improper Medicare payments are being recouped. In this case, overpayments occurred primarily because the University Of Cincinnati Medical Center lacked adequate controls to prevent incorrect billing of Medicare claims within selected risk areas that contained errors, auditors said. The hospital in turn discussed steps it had taken or planned to take to strengthen its internal controls to ensure compliance. Now what? Is there any middle ground? Is such extrapolation extreme at best or warranted due to the sheer volume of Medicare claims?
