Corporate Compliance

Contractor overpays Massachusetts hospitals

Compliance Monitor, January 25, 2007

Associated Hospital Service (AHS), a Medicare contractor based in Maine, made inaccurate payments for claims, according to a recent OIG audit.

AHS made full diagnosis-related group payments for claims that should have been reduced to short-stay outlier payments. The claims also should have been reduced by the beneficiaries' co-insurance amounts for lifetime reserve days.

AHS paid more than $936,000 for 83 claims to eight long-term care hospitals in Massachusetts. The services covered were performed between January 1, 2003 and April 30, 2004. This happened because the intermediary did not ensure that the hospitals' claims contained the appropriate coverage status codes.

As part of the OIG's recommendation to resolve the inaccuracies, AHS agreed to recover the overpayments made to the eight hospitals.

Most Popular