Report: Saint Luke’s Hospital Overbilled Medicare By $581,000
Saint Luke’s Hospital of Kansas City overbilled Medicare $581,000 over a two-year period, a federal report concludes.
The report by the Department of Health and Human Services’ Office of Inspector General (OIG) says the hospital failed to comply with Medicare requirements for 80 of 294 inpatient and outpatient claims reviewed by OIG.
The federal watchdog says that 63 inpatient claims had billing errors, resulting in $366,584 in overpayments, and 17 outpatient claims had billing errors, resulting in $214,634 in overpayments. Most of the claims dated from 2011 and 2012.
“These errors occurred because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors,” the report finds.
In written comments to OIG’s draft report, Saint Luke’s agreed with the findings on 71 of the claims but “strongly disagreed” with its findings on the remaining nine claims, the OIG report says.
“The Hospital said that it strongly believes that the physician determination for admission was justified and medically necessary and added that it intends to appeal these claims,” according to the report.
Saint Luke’s representatives could not immediately be reached for comment on the OIG report.
The report is part of a routine series of hospital compliance reviews of hospitals throughout the country that OIG undertakes.
In 2012, Medicare paid hospitals $148 billion, accounting for 43 percent of all fee-for-service payments, the OIG report says.
In 2011 and 2012, Saint Luke’s, a 410-bed acute care hospital, received $234 million from Medicare for 15,864 inpatient claims and 198,945 outpatient claims, according to the report.
The Saint Luke’s claims questioned by OIG represent 27 percent of the claims it reviewed.
A similar recent review of Saint Anthony’s Medical Center in St. Louis, a 767-bed acute care hospital, said that 20 percent of the claims OIG examined resulted in overpayments of $308,853.
The Council for Medicare Integrity, a Medicare payment watchdog group, recently released a report saying that Missouri providers overbilled Medicare by $170 million in 2013. The group said that made Missouri the fourth worst state in the country for Medicare waste.
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR.
Read the original article here.