Porterville hospital accused of over billing Medicare
Federal auditors have concluded that Sierra View District Hospital in Porterville mistakenly billed Medicare more than $798,000 due to billing errors for 25 patients.
A report released this week by the the U.S.Department of Health and Human Services’ Office of Inspector General states that the the discovery resulted from reviews of Medicare billings on 30 inpatient and outpatient serviced by the hospital in 2012 and 2013.
Five of those patients were properly billed, but “Specifically, 23 inpatient claims had billing errors, resulting in overpayments of $228,969, and 2 outpatient claims had billing errors, resulting in overpayments of $569,095,” the report states.
“These errors occurred primarily because the medical center did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors,” it continues.
For example, two patients who should have been listed as outpatients were billed as being in the hospital because a doctor didn’t document the discharge until three days after they were discharged, resulting in $225,785 improperly billed to Medicare, according to the report.
In another case, the wrong coding was used on a patient’s medical records, resulting in a $3,184 Medicare charge that shouldn’t have occurred, it continues.
Health and Human Services is recommending that the hospital refund all $798,064 in mispayments back to Medicare.
Sierra View did not provide anybody to comment on the Inspector General’s report and instead provide only a brief, written comment saying officials were “disappointed” with the findings of the audit.
“The largest number of the OIG’s identified errors related to inpatient admissions which the hospital considered medically necessary for patient care but, the OIG concluded those patients could have been treated as outpatients. We note that Medicare’s distinction between inpatient and outpatient status is a matter of continuing debate in the healthcare industry,” the statement continues.
A letter to Health and Human Services from the hospital states that “We agree that we were overpaid twice as a result of an incorrect [Healthcare Common Procedure Coding System] code applied to the drug ziv-aflibercept.
“The employee in charge of our charge master incorrectly used the code for the drug aflibercept.”
In another case, the letter from Sierra Vista Chief Executive Officer Donna J. Hefner states, “We agree with your finding that two of the claims were incorrectly admitted as inpatients” and that the hospital has made changes to prevent Medicare billing errors in the future.
“Of the twenty remaining inpatient cases reviewed, we respectfully disagree with the department’s findings that these cases were incorrectly admitted and billed as inpatients,” state the letter, which details each challenge to the federal auditors’ findings.
In an email to the Times-Delta, hospital officials wrote that “We refunded those claims that we agreed were billed incorrectly. However, we are awaiting a final determination of overpayment from the Centers for Medicare and Medicaid Services.”
The review of Sierra View’s billing is part of a series of reviews Health and Human Services does of hospitals around the country using data mining and other techniques to identify reimbursement claims by healthcare providers that may not comply with billing Medicare rules.
Data from the Centers for Medicare and Medicaid Services indicates that in California alone, Medicare was over billed by about $261 million in fiscal 2014-15.
That same year, federal auditors identified $2.39 billion in Medicare overpayment nationally and $173.1 million in Medicare underpayments to healthcare providers.
A September Health and Human Services report on an audit of Tulare Regional Medical Center turned up $178,647 for 10 outpatient surgery claims improperly billed to Medicare. In that case, the hospital didn’t challenge the findings and took actions to prevent such incidents in the future and to reimburse Medicare.
No Inspector General reports on Kaweah Delta Medical Center in Visalia have been released.