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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-05-19-00024
Report Description

This audit is part of a series of hospital compliance audits. Using computer matching, data mining, and data analysis techniques, we identified hospital claims that were at risk for noncompliance with Medicare billing requirements. For calendar year 2018, Medicare paid hospitals $179 billion, which represents 47 percent of all fee-for-service payments for the year.Our objective was to determine whether Lake Hospital System (the Hospital) complied with Medicare requirements for billing inpatient and outpatient services on selected types of claims.

Report Type
Audit
Number of Recommendations
3
Questioned Costs
$4,385,974
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
270866 No $3,091,387 $0

We recommend that Lake Hospital System refund to the Medicare contractor the portion of the $4,385,974 in estimated overpayments for the audit period for claims that it incorrectly billed that are within the 4-year reopening period.

270867 No $0 $0

We recommend that Lake Hospital System 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 (This recommendation does not apply to any overpayments that are both within our sampling frame (i.e., the population from which we selected our statistical sample) and refunded based on the extrapolated overpayment amount.  Those overpayments are already covered in the previous recommendation.).

270868 No $0 $0

We recommend that Lake Hospital System strengthen controls to ensure full compliance with Medicare requirements.

Department of Health & Human Services OIG

United States