Submitting OIG:
Report Description:
Payments that the Medicare contractors for Jurisdiction E (which covers California, Hawaii, Nevada, and three Pacific territories) made to hospitals for 191 inpatient and outpatient claims for replaced cardiac medical devices did not comply with Medicare requirements for reporting manufacturer credits. The hospitals' incorrect billing of these claims resulted in overpayments of $2.1 million that the hospitals had not identified, refunded, or adjusted by the beginning of our audit. The Medicare contractors overpaid the hospitals because they had no specific controls to ensure that hospitals complied with Medicare requirements for reporting manufacturer credits.
Date Issued:
Wednesday, March 16, 2016
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
A-09-15-02029
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
CA
United StatesHI
United StatesNV
United StatesGU
United StatesAS
United StatesMP
United StatesType of Report:
Audit
Questioned Costs:
$2,132,458
Funds for Better Use:
$0
Number of Recommendations:
3
View Document:
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Additional Details Link: