Medicare Compliance Review of WakeMed Raleigh Campus

WakeMed Raleigh Campus (the Hospital), located in Raleigh, NC, complied with Medicare billing requirements for 187 of the 263 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 76 claims, resulting in net overpayments of approximately $250,000 for the audit period. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $697,000 for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.