Hospital Overbilled Medicare
Published: Friday, April 27, 2012
Updated: Friday, April 27, 2012 02:04
Georgetown University Hospital overbilled Medicare by over $659,000 between 2009 and 2010, according to a recent audit released April 9 by the U.S. Department of Health and Human Services’ Office of Inspector General.
The audit reviewed 265 inpatient and outpatient claims and found that only 131 of the claims complied with Medicare billing requirements. While the hospital has acknowledged that the remaining 134 claims were incorrectly filed, it is currently disputing the amounts of some of those charges. The hospital has confirmed $24,718 of the overcharges as billing errors but is currently disputing and reviewing claims pertaining to the remaining $634,653.
“We continue to work closely with OIG to determine a final resolution to this issue,” Marianne Worley, director of media relations for Georgetown University Hospital, wrote in an email.
The hospital’s Medicare contractor had previously flagged the 265 claims as at-risk for incorrect filing. The OIG conducts between 250 and 300 hospital audits each year after being notified of such at-risk claims and frequently finds evidence of overbilling.
“This is extremely typical, extremely routine,” OIG spokesman Donald White said. “This is just an audit. There is no suggestion of any willful wrongdoing or criminal activity.”
White added that the volume of overcharges is unsurprising.
“The hospital will continue to provide documentation, coding and compliance education to coding and billing staff, attending physicians and residents on an ongoing basis,” Paul Warda, vice president for finance and chief financial officer of Georgetown University Hospital, wrote in an official response to the audit.
The executive summary of the official audit attributes the errors to a poor understanding of Medicare billing procedures and a lack of adequate controls to prevent the inaccurate filing of claims, an issue the hospital plans to address.
“The hospital will continue to monitor and audit internal controls and remediate any identified errors,” Warda wrote.