For inpatient claims with certain Medicare Severity Diagnosis-Related Groups (MS-DRGs), Medicare requires that beneficiaries have received 96 or more hours of mechanical ventilation. For 137 of the 200 claims we reviewed, Medicare payments to hospitals complied with Medicare requirements; the beneficiaries had received 96 or more consecutive hours of mechanical ventilation. However, for the 63 remaining claims, Medicare payments to hospitals did not comply with requirements. Consequently, the claims were assigned incorrectly to MS DRGs 207 and 870, resulting in $1.5 million of overpayments. The hospitals confirmed that these claims were improperly billed and generally attributed the errors to incorrectly counting the number of hours that beneficiaries had received mechanical ventilation or to clerical errors in selecting the appropriate procedure code.
| Report Date | Agency Reviewed / Investigated | Report Title | Type | Location | |
|---|---|---|---|---|---|
| Department of Health & Human Services | Medicare Improperly Paid Hospitals for Beneficiaries Who Had Not Received 96 or More Consecutive Hours of Mechanical Ventilation | Audit | Agency-Wide | View Report | |
| Appalachian Regional Commission | Tuppers Plains-Chester Water District State Route 681 Booster Station Improvements | Audit |
|
View Report | |
| Appalachian Regional Commission | Tuppers Plains-Chester Water District Bashan Booster Station Improvements | Audit |
|
View Report | |
| Appalachian Regional Commission | Morehead State University | Audit |
|
View Report | |
| Department of Energy | Audit Coverage of Cost Allowability for URS|CH2M Oak Ridge LLC During Fiscal Years 2011, 2012, and 2013 Under Department of Energy Contract No. DE-SC0004645 | Other |
|
View Report | |
| Department of Veterans Affairs | Review of Community Based Outpatient Clinics and Other Outpatient Clinics of VA Connecticut Healthcare System, West Haven, Connecticut | Review |
|
View Report | |
| Department of Homeland Security | National Flood Insurance Program's Management Letter for DHS' FY 2015 Financial Statements Audit (Redacted) | Audit | Agency-Wide | View Report | |
| Department of Homeland Security | FEMA's Grant Programs Directorate Did Not Effectively Manage Assistance to Firefighters Grant Program - AFG Grants | Audit | Agency-Wide | View Report | |
| Department of State, Department of Homeland Security | FEMA Continues to Experience Challenges in Protecting Personally Identifiable Information at Disaster Recovery Centers | Disaster Recovery Report | Agency-Wide | View Report | |
| Department of State, Department of Homeland Security | Lake County, California, Should Continue to Improve Procurement Policies, Procedures, and Practices | Disaster Recovery Report |
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View Report | |