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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-04-19-08071
Report Description

The Hospital complied with Medicare billing requirements for 54 of the 100 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 46 claims, resulting in overpayments of $1.6 million for the audit period. Specifically, 45 inpatient claims and 1 outpatient claim had billing errors.

Report Type
Audit
Location

CA
United States

Number of Recommendations
3
Questioned Costs
$16,346,371
Funds for Better Use
$0

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
269546 No $16,346,371 $0

1. We recommend that Alta Bates Summit Medical Center refund to the Medicare contractor $16,346,371 ($16,395,489 less $49,118 that the Hospital has already repaid) in estimated overpayments for the audit period for claims that it incorrectly billed.

269547 No $0 $0

2. We recommend that Alta Bates Summit Medical Center based on the results of this audit, exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule, and identify any of those returned overpayments as having been made in accordance with this recommendation.

269548 No $0 $0

3. We recommend that Alta Bates Summit Medical Center strengthen controls to ensure that: (1) all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation and all required documentation is included in the medical records, (2) procedure and diagnosis codes are supported in the medical records and staff are properly trained, (3) all inpatient beneficiaries meet Medicare requirements for inpatient hospital services, (4) the use of bypass modifiers is supported in the medical records, and (5) staff are properly trained.

Department of Health & Human Services OIG

United States