Fierce Healthcare: OIG: Medicare overpays $2.8M to two hospitals and Wisconsin


The Office of Inspector General has released three reports showing two hospitals and the State of Wisconsin collectively over-billed Medicare by $2.8 million.


In the first report, the OIG says Community Regional Medical Center in Fresno, Calif., received $1.1 million in overpayments for 230 inpatient and outpatient claims with dates of service from 2008 to 2012. Investigators conclude the overpayments occurred because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk area that contained errors.


The second report states Boston Medical Center, a 496-bed academic medical center located in the South End of Boston, owes $612,000 in overpayments for 326 inpatient and outpatient claims for calendar years 2009-2011. Investigators blame the errors on failure to have adequate controls in place to prevent the incorrect billing of Medicare claims and not understanding Medicare billing requirements within the selected risk areas that contained errors.

[And] in its third report, the OIG states the Wisconsin Department of Health Services claimed approximately $1.1 million in federal reimbursement for unallowable high-dollar payments it made to hospitals for inpatient services for 84 claims with dates of service from Jan. 1, 2006 through Dec. 31, 2009. Inspectors say the overpayments occurred because hospitals reported incorrect charges. But hospital officials attributed the incorrect charges to data entry errors.

Read more about the OIG’s investigation here.

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