Medicare Hospital Provider Compliance Audit: Edward W. Sparrow Hospital

This audit is part of a series of hospital compliance audits. Using computer matching, data mining, and other data analysis techniques, we identified hospital claims that were at risk for noncompliance with Medicare billing requirements. For calendar year (CY) 2017, Medicare paid hospitals $206 billion, which represents 55 percent of all fee-for-service payments; accordingly, it is important to ensure that hospital payments comply with requirements.Our objective was to determine whether Edward W. Sparrow Hospital (the Hospital) complied with Medicare requirements for billing inpatient and outpatient services on selected types of claims.