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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-04-18-08068
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 2017, Medicare paid hospitals $206 billion, which represents 55 percent of all fee-for-service payments for the year.

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
0
Questioned Costs
$0
Funds for Better Use
$0

Open Recommendations

This report has 1 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268005 No $0 $0

We recommend that the Texas Health Presbyterian Hospital Dallas strengthen controls to ensure full compliance with Medicare requirements, specifically: - ensure all IRF beneficiaries meet Medicare criteria for acute inpatient rehabilitation and all required documentation is included in the medical record: - ensure all inpatient beneficiaries meet Medicare criteria for inpatient hospital services; - ensure procedure and diagnosis codes are supported in the medical records and staff are properly trained; and - ensure HCPCS codes are supported in the medical records and staff are properly trained.

Department of Health & Human Services OIG

United States