Houston Methodist Hospital failed to comply with Medicare billing requirements for 48 of 159 inpatient and outpatient claims reviewed by HHS’ Office of the Inspector General during the audit period of Jan. 1, 2012, through Dec. 31, 2013, according to an OIG report.
The 48 claims — 47 inpatient and one outpatient — that did not comply with Medicare billing requirements resulted in the hospital receiving $609,346 in overpayments.
The OIG also reviewed five inpatient claims as a separate nonstatistical sample. Houston Methodist incorrectly billed three of those five claims, resulting in overpayments of $67,656.
Extrapolating from the sample results, the OIG estimated Houston Methodist received at least $1.27 million in overpayments from Medicare during the audit period.
Based on its findings, the OIG recommended the hospital refund the Medicare contractor net overpayments for claims that were incorrectly billed during the three-year recovery period and work with the Medicare contractor to return overpayments that were made outside the three-year recovery period. The OIG also recommended the hospital strengthen controls to ensure full compliance with Medicare requirements.
Houston Methodist disagreed with the OIG’s findings regarding 21 of the claims and said it would appeal the determinations on the basis of its independent physician reviewer’s determinations and the clinical merits of these cases.
After reviewing the hospital’s comments, the OIG maintained its findings and recommendations.