Medicare Overpaid Hospital $11.5 Million

Hospital Received $11.5M in Medicare Over-payments

Florida Hospital Orlando may have received more than $11 million in over-payments from Medicare from January 1, 2011, through June 30, 2012, according to a recently released Office of the Inspector General (OIG) audit report.

During the audit period, Medicare paid the hospital approximately $647 million for 79,750 inpatient claims and more than 343,000 outpatient claims. The audit itself focused on more than $80 million paid by Medicare to the hospital for nearly 11,000 claims that the OIG identified as being at risk for billing errors. Auditors then focused on a random selection of 215 inpatient claims, according to the report.

The hospital failed to comply with Medicare billing requirements for 94 of the 215 selected claims, which resulted in over-payments of more than $493,000. The auditors attributed the errors to the hospital’s lack of adequate controls to prevent incorrect Medicare billing.

Based on the result of the 215 claims selected for the audit, the OIG estimated the hospital received more than $11 million in over-payments during the audit period. The OIG recommended the hospital refund to Medicare $11,512,530 in estimated over-payments and strengthen its controls to ensure full compliance with Medicare billing requirements.

Florida Hospital Orlando disagreed with the OIG’s findings. The hospital contended that it did not improperly bill 70 of the 94 improper claims the OIG identified in its audit. The hospital also objected to the lack of clarity in the OIG’s findings and the OIG’s use of sampling and extrapolation to calculate the over-payment.

After receiving the hospital’s comments and objections, the OIG maintained its findings and recommendations.

(Becker’s Website)