Memorial Health University Medical Center in Savannah did not comply with Medicare billing requirements for 39 out of 131 inpatient and outpatient claims reviewed by the U.S. Department of Health and Human Services’ Office of Inspector General, according to an OIG report.
This noncompliance resulted in a combined overpayment to the hospital of nearly $600,000 in 2015 and 2016, the February report released last month stated. The inspector general looked at claims from Memorial as part of a series of reviews nationwide undertaken after data analytics identified certain claims risked not complying with Medicare billing requirements.
On the basis of the sample results, the inspector general estimated that the hospital received overpayments of at least $1.4 million for the audit period.
The agency recommended that the hospital refund Medicare a little more than $1.3 million—a figure that took into account the $155,072 that the hospital had already repaid. It also recommended that Memorial “exercise reasonable diligence to identify and return any additional similar overpayments received outside of our audit period” and “strengthen controls to ensure full compliance with Medicare requirements,” according to the 17-page report.
Memorial, in written comments on the draft report, did not agree with 17 of the 39 claims errors that the inspector general identified. Those claims were specific to inpatient rehabilitation services, according to the hospital.
In those cases, the hospital said, the records were audited not by the inspector general but by a contractor that did not allow Memorial to submit additional documentation during the audit process.
“Memorial believes the additional documentation for these 17 claims … clearly supports the patients’ eligibility for and the medical necessity of the services provided,” according to the hospital’s comments. “As a result, Memorial will appeal the findings … and is confident that, with the additional documentation, the services will be found to have been medically necessary.”
After reviewing these comments, the OIG maintained the accuracy of its findings and recommendations.