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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-04-19-08077
Report Type
Audit
Number of Recommendations
3
Questioned Costs
$13,486,524
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
271007 No $7,787,742 $0

1. We recommend that Jewish Hospital refund to the Medicare contractor $13,486,524 in estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year claim reopening period.

271008 No $0 $0

We recommend that Jewish Hospital 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.

271009 No $0 $0

We recommend that Jewish Hospital strengthen internal controls by: strengthening procedures to verify that all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation, developing processes to ensure that procedure and diagnosis codes are supported in the medical records, providing additional training to inpatient and outpatient coding staff on the use of bypass modifiers, and developing procedures to verify that the use of bypass modifiers is supported in the medical records.

Department of Health & Human Services OIG

United States