Portland Business Journal: OHSU and other Oregon hospitals overbilled Medicare by millions

From the Portland Business Journal:

OHSU and other Oregon hospitals overbilled Medicare by millions

Oregon hospitals overbilled Medicare $23 million in 2013, an increase of $8 million over the previous year, a new analysis has revealed.

The state’s overbilling does not place Oregon high on a list of the worst states with Medicare waste — it only ranks 39th out of the 50 states — but does contribute to mismanagement that drained $46 billion in lost funds from the Medicare Trust Fund in 2014, says the advocacy group Council for Medicare Integrity.

“If every state’s doing this to varying degrees, you can understand why there’s a $46 billion loss to Medicare over the past year alone due to overbilling,” council spokeswoman Kristin Walter said.

Much of the overbilling occurs due to bookkeeping and billing mistakes, Walter said. Procedures are billed incorrectly, or are mistakenly billed to Medicare multiple times. Medicare fraud also occurs, but less frequently.

That’s mainly what happened with Oregon Health & Science University between 2010 and 2012, during which the hospital ran up more than $2.4 million in Medicare overbillings from 57 incorrectly billed inpatient claims, according to an October 2014 review by the Department of Health and Human Services.

More than three-quarters of the OHSU overbillings occurred due to a paperwork mix-up over bone marrow and stem cell transplants, says the report from the HHS Office of Inspector General. OHSU staff billed the procedures as inpatient care when they should have been billed as outpatient care.

In a response letter, OHSU agreed with the findings and said it had already refunded the $2.4 million.

Medicare overbilling is a growing problem in the U.S., with the rate of improper payments rising steadily from 8.6 percent to 12.7 percent between 2011 and 2014, the Council for Medicare Integrity states.

The group advocates for the continued funding of the Recovery Audit Contractor Program, under which the Centers for Medicare and Medicaid Services hires auditing firms to review Medicare payments for errors.

The program has an average accuracy rating of 96 percent and has recovered more than $8.9 billion in improper Medicare payments since its inception in 2009.

Examples of billing mistakes found by auditors include:

  • Home health care that started after beneficiaries’ deaths
  • Oncology radiation calculations that were billed by a provider and a physicist one week before the patient was seen in the office
  • Drugs paid for 10 times the amount administered
  • Hospital claims coded with illnesses the patient didn’t have
  • Excessive units of medication, where the billed dose would be harmful or lethal

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