Chicago Tribune: Analysis finds NorthShore allegedly overbilled Medicare by $4.1 million in 2013-14

Analysis finds NorthShore allegedly overbilled Medicare by $4.1 million in 2013-14

NorthShore University HealthSystem allegedly overbilled Medicare by at least $4.1 million from 2013 to 2014, according to a report released Monday by the U.S. Department of Health and Human Services Office of Inspector General.

The report, Medicare Compliance Review of NorthShore University HealthSystem for 2013 and 2014, alleges that the hospital system erroneously billed Medicare in 49 percent of Medicare claims, according to a press release from the Council for Medicare Integrity. The nonprofit organization advocates for proper Medicare billing, according to its website.

 The legal billing error rate threshold is 10 percent, CMI indicates.

Representatives from NorthShore said they are appealing the report.

The statement said authors of the report never asked whether the care provided at NorthShore was deemed medically necessary or how it complied with the system’s standardized care protocols.

“These protocols consistently undergo robust internal audits to ensure the highest levels of patient safety and care are met,” the statement read.

The review was done as part of a series of hospital Medicare compliance reviews, according to the report. Investigators examined whether NorthShore properly complied with Medicare billing rules for select claims. Both inpatient and outpatient services were studied.

The report recommended that NorthShore return $4.1 million in Medicare overpayments from 2013 to 2014, check for additional overpayments in other audit years and pay back that money as well and tighten controls to ensure better compliance with Medicare rules.

NorthShore University HealthSystem has nearly 800 beds and includes hospitals in Evanston, Glenbrook, Highland Park and Skokie.

The report is available at https://oig.hhs.gov.

Read the original story here.

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