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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
Medicare Contractor Payments to Providers for Hospital Outpatient Dental Services in Jurisdiction H Generally Did Not Comply With Medicare Requirements
Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 91 did not comply with Medicare requirements. Using our sample results, we estimated that Medicare contractors improperly paid providers in Jurisdiction H at least $1.7 million from January 1, 2012, through August 31, 2014.
DePaul Health Center (the Hospital) (operating in Bridgeton, Missouri) complied with Medicare billing requirements for 190 of the 204 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 14 claims (all of which were inpatient claims), resulting in overpayments of $81,000 for calendar years 2012 and 2013. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.
