Federal Reports

North Carolina Baptist Hospital (the Hospital), located in Winston Salem, North Carolina, complied with Medicare billing requirements for 209 of the 246 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 37 claims, resulting in net overpayments of approximately $221,000 for the audit period. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.4 million for the audit period. 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.

The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCU or Unit). This MFCU Fiscal Year (FY) 2015 Annual Report highlights statistical achievements from the investigations and prosecutions the 50 MFCUs conducted for FYs 2011 through 2015. The report also identifies improvements made in Unit operations.

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess the Unit's adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.