The $267,000 was based on the results of a sample of 213 reviewed claims. Of the 213 inpatient and outpatient St. Vincent claims, 22 of the claims did not fully comply with Medicare’s billing requirements, resulting in $267,000 in overpayments.
The OIG recommended St. Vincent refund the $267,000 and strengthen controls to ensure full billing requirement compliance.
Although the hospital did not contest audit findings with respect to 13 outpatient claims and four inpatient claims, it did “strongly disagree” with the findings in regard to the clinical merits of five inpatient claims.
The OIG reviewed St. Vincent’s claims and maintained their findings.
More articles on payer issues:
New rules proposed for health insurers in California
UnitedHealth Group reports 5.8% increase in earnings
Colorado’s health plan price differences and the PPACA
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
