Health Information Management

Florida Hospital Orlando received more than $11 million in Medicare overpayments

HIM-HIPAA Insider, May 4, 2015

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by Jaclyn Fitzgerald, Editor

Florida Hospital Orlando may have received more than $11 million in overpayments from Medicare from January 1, 2011, through June 30, 2012, according to a recently released Office of the Inspector General (OIG) audit report. The OIG instructed the hospital to refund Medicare for the estimated overpayments and strengthen its controls to fully comply with Medicare billing requirements.
During the audit period, Medicare paid the hospital approximately $647 million for 79,750 inpatient claims and more than 343,000 outpatient claims. The audit itself focused on more than $80 million paid by Medicare to the hospital for nearly 11,000 claims that the OIG identified as being at risk for billing errors. Auditors then focused on a random selection of 215 inpatient claims, according to the report.
The hospital failed to comply with Medicare billing requirements for 94 of the 215 selected claims, which resulted in overpayments of more than $493,000. The auditors attributed the errors to the hospital’s lack of adequate controls to prevent incorrect Medicare billing. Based on the result of the 215 claims selected for the audit, the OIG estimated the hospital received more than $11 million in overpayments during the audit period. The hospital argued that the OIG incorrectly identified 79 of the 94 claims as noncompliant, according to the report.

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