News: OIG audit finds Ohio hospital owes millions in overpayments

CDI Strategies - Volume 14, Issue 25

According to an audit from the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), the Ohio State University Hospital received millions in overpayments during the audit period because of coding and billing errors.

The OIG audit report states that the hospital complied with Medicare billing requirements for 98 of the 145 inpatient and outpatient claims that were audited, however it did not fully comply with the remaining 47 claims. It is estimated that this resulted in net overpayments of $335,832 for the audit period, and that in total Ohio State University Hospital received overpayments of “at least $3.7 million” for the audit period based on the OIG’s extrapolation.

Specifically, the OIG found errors in inpatient rehab facility service claims, MS-DRG assignments based on incorrect coding, and errors in patient status (inpatient versus outpatient).

The OIG recommends the hospital refund the $3.7 million of the estimated overpayments to the Medicare contractor for the claims incorrectly billed services that are within the four-year claim reopening period.

Ohio State University Hospital agreed with some of the errors identified in the sample and repaid Medicare $396,025. However, the hospital disagreed with most of the OIG findings, recommendations, extrapolation, audit design, and methodology.

The OIG notes that “after review and consideration of the Hospital’s comments, [they] maintain that [their] findings and the associated recommendations are valid.” The OIG also notes that “the use of statistical sampling to determine overpayment amounts in Medicare is well established and has repeatedly been upheld on appeal in Federal courts.”

According to the OIG, they employed an independent medical review contractor that reviewed the records in their entirety to determine medical necessity and whether they met coverage and documentation requirements.  

Editor’s note: The full HHS report can be found here. To read more about audit activity and recent cases, click here.

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