News: Medical Center received nearly $1.7 million in overpayments, OIG says

Medicare incorrectly paid approximately $1.7 million to Carolinas Medical Center in Charlotte, North Carolina, as a result of incorrect billing on the part of the medical center, Revenue Cycle Advisor reported.

The OIG estimated the final overpayment amount by reviewing 240 inpatient claims for the medical center. Through the audit, the OIG found that the facility failed to comply with Medicare billing requirements for 83 claims. The billing errors resulted in $331,831 in overpayments from January 1, 2014, through December 31, 2015.

The OIG attributed the Carolinas Medical Center claim errors to inadequate controls for preventing incorrect billing, including:

• Incorrect DRG codes: The facility disagreed with the OIG about some DRG errors, but since the audit adopted additional controls and training to prevent such errors on future claims.
• Incorrectly billing same-day readmissions that should have been billed as part of the initial hospital stay when the reason for readmission was related to the initial stay: These claims could have been billed as a continuous stay. Some of the readmissions were attributed to the patient leaving against medical advice and later returning to the hospital. Others were related to billing staff failing to combine claims because they were unaware that patients treated in the detox unit were inpatients.
• Incorrectly billing Part A for a patient who did not have an inpatient order: The hospital attributed this mistake to a bill processing error and stated that it did not follow the correct processes for rebilling the claim as outpatient.

Carolinas Medical Center disagreed with several of the OIG findings, according to Revenue Cycle Advisor. The OIG stands by its findings, however, and recommends that the facility refund overpayments. 

Editor’s note: This article originally appeared in Revenue Cycle Advisor. To read the full OIG report, click here. To read about how to use the OIG Work Plan for your CDI efforts, click here. To read about the American Hospital Association’s criticism of the OIG’s auditing tactics, click here.