FOR IMMEDIATE RELEASE
CONTACT: Kristin Walter
2015/2016 Medicare Compliance Reports: Missouri Overbilled Medicare By More than $2 Million
Washington, D.C. – A report released this week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) found that Freeman Hospital in Joplin, Missouri overbilled Medicare $311,447 from 2011to 2012. According to the OIG, 20 percent of the hospital’s Medicare claims were improperly billed.
According to a 2015 report from the Centers for Medicare and Medicaid Services (CMS), overall Missouri providers overbilled Medicare by more than $32.5 million in FY2014, with an average of $40.41 misbilled per Medicare beneficiary in the state.
Additionally, in reports released in 2015 and 2016, the OIG found that select Missouri hospitals overbilled Medicare collectively by more than $2 million. The hospitals include:
- Missouri Baptist Medical Center, St. Louis — $413,757 in overbillings
- Mercy Hospital, St. Louis — $329,054 in overbillings
- Saint Anthony’s Medical Center, St. Louis — $308,853 in overbillings
- Saint Luke’s Hospital of Kansas City, Kansas City — $581,218 in overbillings
- Saint Luke’s Hospital of Chesterfield, Chesterfield — $119,721 in overbillings
- Freeman Hospital, Joplin — $311,447 in overbillings
According to the Council for Medicare Integrity, a nonprofit group that advocates for proper Medicare billing, Freeman Hospital’s improper billing is part of a nationwide problem. Since 2011, the rate of Medicare Fee-for-Service (FFS) improper payments has risen steadily from 8.6 percent to 12.1 percent, with a loss of more $40 billion annually to the Medicare Trust Funds.
In an effort to reduce waste within Medicare, the Recovery Audit Contractor (RAC) Program was put in place by Congress in 2009 to review Medicare FFS post-payment claims to identify and recover improper payments made to providers. The program currently reviews only 0.5 percent of a provider’s post-payment inpatient claims, meaning 99.5 percent of these claims go un-reviewed.
Senator Claire McCaskill (D-MO), the Chairman and Ranking Member on the U.S. Senate Special Committee on Aging, has credited the RAC Program with returning $10 billion back to the program and extending its life by two years.
“Improper payments are a real cause of concern, especially in light of recent government reports predicting the end Medicare Part A in 2026 – just 10 years from now,” said Kristin Walter, spokesperson for the Council for Medicare Integrity. “As baby boomers in Missouri increasingly become eligible for Medicare, and life expectancy continues to rise at the same time that costs of medical treatments are increasing, the question becomes, ‘Will Medicare be there when you need it?’”
For more information, please visit: www.medicareintegrity.org.
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About the Council for Medicare Integrity
The Council for Medicare Integrity is a 501(c)(6) non-profit organization. The Council’s mission is to educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help Medicare identify and correct improper payments.