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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-06-16-01002
Report Description

Medicare makes supplemental payments to hospitals, known as outlier payments, which are designed to protect hospitals from significant financial losses resulting from patient-care cases that are extraordinarily costly. Unlike predetermined payment amounts for most Medicare hospital claims, outlier payments are directly influenced by hospital charges. We selected CHI St. Vincent Infirmary (St. Vincent) based on outpatient outlier payments increasing from $216,484 in 2013 to $1.4 million in 2014.

Report Type
Audit
Location

Little Rock, AR
United States

Number of Recommendations
5
Questioned Costs
$362,999
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region6/61601002.asp
External Entity
CHI St. Vincent Infirmary

Open Recommendations

This report has 4 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268323 No $0 $0

We recommend that CHI St. Vincent Infirmary amend the 33 claims (10 incorrectly amended and 23 not amended) to identify and return any improper outlier payments that are within the 4-year claims reopening period

268325 No $0 $0

We recommend that CHI St. Vincent Infirmary exercise reasonable diligence to identify and return any additional similar overpayments (including overpayments received during our audit period for the remaining $1,072,249 in outlier payments that we did not review and overpayments outside of our audit period), in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

268306 No $362,999 $0

We recommend that CHI St. Vincent Infirmary return the $362,999 in improper outlier payments for the 70 claims that have been amended correctly.

268307 No $0 $0

We recommend that CHI St. Vincent Infirmary improve procedures and provide education to ensure claims billed to Medicare are accurate.

Department of Health & Human Services OIG

United States