The Department of Health and Human Services has asked the University of Miami Hospital to pay back $3.7 million to Medicare for incorrectly billed inpatient claims uncovered in an audit but the hospital is disputing the governmentâ€™s calculations.
The overpayments, received by the hospital from April 1, 2009 through Dec. 31, 2010, occurred because the provider had weaknesses in some of its financial, coding and management controls to prevent incorrect billing, the HHS Office of Inspector General said in a report released Tuesday. In addition to the amount to be refunded, the OIG recommended the hospital strengthen its controls.
The hospital agreed to the majority of the OIGâ€™s recommendations but disagreed with the methodology the agency used to determine the amount to be refunded and asked the government to modify the refund.
[See also: Shands to pay $26M for false claims]
During 2009 and 2010, Medicare paid the University of Miami Hospital, a 560-bed acute care facility, about $223 million for 20,953 inpatient and 24,535 outpatient claims for services to beneficiaries.
The auditor flagged about $22.8 million payments to the hospital at potential risk for billing errors and selected a stratified random sample of selected types of claims for close inspection to evaluate whether the provider complied with Medicare requirements.
The OIG found that the hospital had incorrectly billed for short stays, excess charges because of patient discharge status, same-day discharges and readmissions, incorrect high-severity-level diagnosis-related group (DRG) codes, and credits for manufacturer replacement of medical devices that were not obtained.
The hospital did not dispute most of the findings but disagreed that it improperly billed some of the claims, for which the OIG had an independent medical review. The hospital also objected to the use of an audit sample from which to determine the results, saying that in other hospital cases overpayment recommendations were based on actual audited cases and not extrapolation from samples.
The OIG noted in the report that the extrapolation methodology has been successfully used before and continued to stand by the refund amount of $3.7 million.
The hospital, however, continues to push its case with the OIG, according to a story published by the Miami Herald on Tuesday. The newspaper reported the hospital as saying it is working with the government â€śto determine the correct amount owed for billing inaccuracies.â€ť
Donald White, spokesman for the OIG, told the newspaper that the renegotiation process usually takes 60 to 90 days but that with the federal shutdown, it will likely take longer.