Times-Picayune: Lafayette General overbilled Medicare by $4.4M, feds say

Lafayette General overbilled Medicare by $4.4M, feds say

Lafayette General.jpg
Lafayette General Hospital (Lafayette General Health)

Kevin Litten, NOLA.com | The Times-PicayuneBy Kevin Litten, NOLA.com | The Times-Picayune
on May 18, 2016 at 3:35 PM

Lafayette General Medical Center overbilled the federal Medicare program by $4.4 million from 2013 to 2014, according to a government report issued this week, a finding that the hospital disputes.

The Department of Health and Human Services’ inspector general said it reviewed 134 claims made by Lafayette General and found that 69 of those claims were made incorrectly. Those claims were worth about $865,000, and using that as a basis to project total Medicaid errors, the inspector general estimated the hospital was paid $4.4 million for incorrect claims for 2013-14.

Hospital spokesman Daryl Cetnar challenged the conclusion, saying that most claims “were properly billed,” and the hospital will “appeal each claim, one by one, until resolution is achieved.”

The hospital agreed with some of the inspector general’s findings, and refunded the Medicare program nearly $262,000. Medicare is a federally administered program, unlike the state-run Medicaid program, so the report did not include a review of Medicaid payments the hospital received.

The report does not accuse Lafayette General of fraudulent claims or abuse of the Medicare program. The claims it identified were for services “not reasonable and necessary for the diagnosis or treatment of illness or injury.” The hospital told the inspector general that seven of the incorrect billings were due to a clerical error.

Medicare data on payments to doctors and medical organizations in 2012 has several limitations that could lead to some misinterpretations, according to the American Medical Association, which represents doctors.  The data, released last week by the Centers for Medicare and Medicaid Services, includes payments to individual doctors and other providers totaling more than $77 billion in 2012.  “Medicare claims…

A spokeswoman for the nonprofit Council for Medicare Integrity, Kelly Davis, said Louisiana is first in the nation for Medicare billing errors. An estimated 19.4 percent of Medicare billings were considered overbilling in Louisiana; the national average is about 12 percent.

“The problem of improper payments does not lie within one Medicare provider or state, but is a nationwide issue that deserves attention from our nation’s lawmakers,” Davis said in a statement.

It’s not clear why Louisiana’s improper payment rate is higher than other states. But the problem is a costly one: The 19.4 percent error rate represents about $1.25 billion.

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