Health Information Management

News: Florida hospital was overpaid $2.6 million over two years

CDI Strategies, November 12, 2015

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Boca Raton Regional Hospital in Florida was overpaid $2.6 million over two years, according to an article in Medicare Compliance Review. The Office of Inspector General audited a stratified random sample of 211 claims and made errors on 50 for a net overpayment of $514,449, the OIG said.

Errors included admissions which should have been billed as outpatient or observation services. They also found claims that were incorrectly coded and led to higher-paying DRGs, and a transfer reimbursed as if it were a discharge. 

In a written response, included in the report, Gadi Weinreich, an attorney for the hospital with Dentons US LLP in Washington, D.C., objected parts of the review, such as the use of 2011 claims. In 2011, the Medicare contractor initially determined that the payment was authorized, therefore Weinreich says Medicare is violating the federal law that places a three-year time limit on the reopening and recovery of alleged overpayments.

The hospital also questioned the “statistics integrity” of the OIG’s extrapolation for the 2012 overpayments. The hospital will appeal 18 of the OIG’s admissions that were declared medically unnecessary for the site of services, Weinreich says.

To read the full OIG report, click here.



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