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Report File
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-07-17-05102
Report Description

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 2016, Medicare paid hospitals $170 billion, which represents 46 percent of all fee-for-service payments for the year.

Report Type
Audit
Location

Santa Fe, NM
United States

Number of Recommendations
4
Questioned Costs
$5,533,169
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region7/71705102.asp
External Entity
St. Francis Health Center

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268343 No $5,533,169 $0

We recommend that Saint Francis Health Center: refund to the Medicare contractor $5,533,169 of the estimated overpayments for the claims incorrectly billed that are within the Medicare reopening period.

268344 No $0 $0

We recommend that Saint Francis Health Center for the remaining portion of the estimated $5,533,169 overpayment for claims that are outside of the Medicare reopening period, exercise reasonable diligence to identify and return overpayments, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation

268345 No $0 $0

We recommend that Saint Francis Health Center exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation.

Department of Health & Human Services OIG

United States