OIG: hospital must return $23.6 million in Medicare overpayments

As many readers of our Michigan legal blog know, the Medicare audit appeals process has relatively small timeframes in which providers can object to claims of overpayments.

The good news for a Las Vegas hospital recently audited by the Office of the Inspector General is that its initial timely response to an audit meant that it was able to reduce the amount the OIG wants refunded for Medicare billing errors by $8,914. The reduction followed Sunrise Hospital & Medical Center’s submission of a handful of claims for reprocessing.

The bad news is that the Health and Human Services (HHS) watchdog insists on the return of the remaining portion of what it claims is $23.6 million in overpayments resulting from Medicare billing errors.

OIG’s audit sample

The OIG reviewed 100 inpatient and outpatient claims for the audit period from Jan. 1, 2017, through Dec. 31, 2018.

The OIG said Sunrise “complied with Medicare billing requirements for 46” of the reviewed claims, but “did not fully comply” on “the remaining 54 claims, resulting in net overpayments of $999,950 for the audit period.”

The federal office said 50 inpatient claims and four outpatient claims contained billing errors.

On the basis of the sample results, OIG estimated that Sunrise “received overpayments of at least $23.6 million for the audit period.”

Hospital’s response

In a statement on the hospital’s website, the Sunrise CEO said, “We strongly disagree with the OIG’s audit findings related to our IRF (Inpatient Rehabilitation Facility) and because we believe the care we provided to our patients was necessary and effective, we will appeal those findings in due course.”

The OIG stated that it reviewed and considered Sunrise’s response, but “we maintain that our findings and recommendations are correct.” It added that its use of statistical sampling to extrapolate overpayments “is well established and has repeatedly been upheld on appeal in Federal courts.”