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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 Compliance Review of Wesley Medical Center for 2012 and 2013
Wesley Medical Center (the Hospital) (operating in Wichita, Kansas) complied with Medicare billing requirements for 208 of the 246 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 38 claims, resulting in overpayments of $182,000 for calendar years 2012 and 2013. Specifically, 27 inpatient claims had billing errors, resulting in overpayments of over $92,000, and 11 outpatient claims had billing errors, resulting in overpayments of over $89,000. 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 (MFCUs or Units). This MFCU Fiscal Year (FY) 2016 Annual Report highlights statistical achievements from the investigations and prosecutions the 50 MFCUs conducted for FYs 2012 through 2016. The report also identifies beneficial practices noted in OIG onsite review reports.
The audit assessed the effectiveness and adequacy of management controls in place for refiles of IRS records at six FRCs: Atlanta, Dayton, Kansas City, Kingsridge, Lee’s Summit, and Lenexa.
