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OIG: Rush University Medical Center overbilled Medicare by $10.2M

Rush University Medical Center in Chicago failed to comply with Medicare billing requirements for 57 of 120 inpatient and outpatient claims reviewed by HHS’ Office of Inspector General, according to a recent OIG report.

The 57 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $814,150 in combined overpayments during 2014 and 2015, according to the OIG.

Extrapolating from the sample results, the OIG estimated Rush University Medical Center received approximately $10.2 million in overpayments from Medicare during the audit period.

Based on its findings, the OIG recommended the hospital refund Medicare $10.2 million, exercise reasonable diligence to identify and return any additional overpayments received outside of the audit period, and strengthen controls to ensure full compliance with Medicare requirements.

In written comments on the OIG’s draft report, Rush University Medical Center generally disagreed with the OIG’s findings and recommendations. The hospital disagreed with the majority of the findings on the inpatient rehabilitation claims reviewed and said it does not have a sufficient understanding of the OIG’s sample methodology to confirm the agency’s extrapolated amount.

In a letter sent to the regional inspector general for audit service in October, Janis Anfossi, associate compliance officer at Rush, said the hospital’s compliance program undertook a six-year look-back audit for rehabilitation reimbursement that covered Jan. 1, 2011, through Dec. 31, 2016. “We believe the financial error rate across this period to be substantially less than what OIG identified in its sample,” stated the letter.

Rush said it is committed to working with government representatives regarding a process for quantifying any overpayment and potential refund amounts.

Full article found here.

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