Experts say hospitals overbill Medicare because it’s too complex
ILLINOIS NEWS NETWORK
One of Illinois largest hospital systems overbilled Medicare nearly half of the time for two years. A watchdog group on the matter said it’s because they often can’t understand the rules.
The U.S. Department of Health and Human Services Office of Inspector General said NorthShore University Health System received north of $4.1 million in unearned Medicare payments in just 2013 and 2014.
Kristin Walter with the Council for Medicare Integrity said the overcharges aren’t likely purposeful, but because the system is so complicated that the hospitals are making mistakes.
“The wrong code is billed to a lot of the time,” she said. “Sometimes there’s ‘up-coding,’ where a provider or hospital is seeking a higher reimbursement than is allowable for a particular service that been offered. That money just goes out the door at such a rate that no one can possibly catch all of it.”
Walter said this likely will cost taxpayers billions.
“It’s costing us our taxpayer dollars that are greatly needed to keep Medicare going,” she said.
Medicare trustees say the system will be bankrupt by 2028 without reforms to the system.
Representatives with NorthShore would not comment on the story.