16 Hospitals the OIG Has Tagged for Medicare Overpayments So Far in 2013

By Bob Herman for Becker’s Hospital Review

The HHS’ Office of Inspector General has ramped up its auditing and compliance review efforts over the past several years under President Barack Obama, especially in how hospitals and health systems are billing Medicare for inpatient and outpatient services.

Here are 16 hospitals that have undergone OIG compliance reviews. In each of the OIG’s audits, the hospital was found to have incorrectly billed Medicare, mostly due to errors with inpatient claims that should have been billed as outpatient or observation.

Note: The following information is based on the OIG’s hospital-specific Medicare compliance reviews from Jan. 1 through June 30, published on its website, and does not include other self-reported audits. The list only includes hospitals based in the United States. The list starts with hospitals most recently reviewed by the OIG.

  1. Baptist Medical Center South (Montgomery, Ala.). An audit found the 454-bed Baptist had several errors in inpatient and outpatient claims during 2009 and 2010, resulting in $1.78 million in Medicare overpayments.
  2. Tufts Medical Center (Boston). The OIG said Tufts must repay the federal government $1.09 million after the 415-bed hospital incorrectly billed Medicare on inpatient short stays and same-day discharges in 2009 and 2010. Tufts officials plan to appeal the audit.
  3. Boston Medical Center. A compliance review found the 508-bed Boston Medical Center received $612,063 in overpayments from Medicare.
  4. Community Regional Medical Center (Fresno, Calif.). The OIG said 625-bed Community Regional Medical Center must refund $1.08 million for erroneous inpatient and outpatient Medicare claims for services provided during 2008 through 2011.
  5. The Brooklyn (N.Y.) Hospital Center. The 464-bed Brooklyn Hospital Center received $544,783 in Medicare overpayments during 2010 and 2011, mostly due to incorrectly billing inpatient claims.
  6. Rapid City (S.D.) Regional Hospital. An audit of the 368-bed Rapid City Regional found $256,789 in overbilled Medicare funds.
  7. Saint Thomas Hospital (Nashville, Tenn.). The OIG said 541-bed Saint Thomas overbilled the government by $1.09 million during 2009 and 2010 for inpatient services that should have been billed as outpatient or observation, and Saint Thomas officials argued the hospital should keep the difference between payments.
  8. Cedars-Sinai Medical Center (Los Angeles). OIG officials said Cedars-Sinai overbilled Medicare more than $2.24 million over a three-and-a-half-year stretch, with most overpayments resulting from inpatient billing errors.
  9. Somerset (Pa.) Hospital. The 150-bed Somerset Hospital will have to refund $313,443 to the government after an audit found outpatient and inpatient billing errors.
  10. Lahey Hospital & Medical Center (Burlington, Mass.). Lahey, a 317-bed teaching hospital, was found to have inadvertently overbilled Medicare by $736,220, though Lahey officials argued the validity of the OIG’s audit on inpatient short stays.
  11. Sanford USD Medical Center (Sioux Falls, S.D.). In 2010 and 2011, the OIG said the 545-bed Sanford USD Medical Center received $12,222 in Medicare overpayments due to five incorrectly billed claims.
  12. North Shore Medical Center (Salem, Mass.). North Shore Medical Center, a two-hospital system part of Boston-based Partners HealthCare, repaid $816,000 in Medicare payments after an audit found several errors in the organization’s Medicare billing processes.
  13. Saint Michael’s Medical Center (Newark, N.J.). Saint Michael’s Medical Center, a 357-bed hospital, was urged to give back $492,046 in Medicare payments after the OIG said the hospital had several errors in its inpatient and outpatient claims.
  14. Norwalk (Conn.) Hospital. The OIG found the 328-bed Norwalk Hospital improperly received roughly $2.74 million in Medicare payments due to errors in inpatient rehabilitation facility claims.
  15. Baton Rouge (La.) General Medical Center. Incorrect inpatient and outpatient claims led to $372,913 in Medicare overpayments at the 544-bed Baton Rouge General, which the OIG said occurred during 2009 and 2010.
  16. California Pacific Medical Center (San Francisco). OIG officials said the Pacific campus of the 785-bed academic medical center complied with Medicare billing requirements for only 63 of 224 inpatient and outpatient claims, which resulted in $1.22 million in overpayments.
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