Federal Reports

University of Mississippi Medical Center (the Hospital) (operating in Jackson, Mississippi) complied with Medicare billing requirements for 137 of the 217 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 80 claims, resulting in net overpayments of $68,000 for the audit period. Specifically, 12 inpatient claims had billing errors, resulting in net overpayments of $41,000 and 68 outpatient claims had billing errors, resulting in net overpayments of $27,000. 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. On the basis of our sample results, we estimated that the Hospital received net overpayments of at least $356,000 for the audit period.

NorthShore University HealthSystem (the Hospital) complied with Medicare billing requirements for 97 of the 190 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 93 claims, resulting in overpayments of $625,000 for CYs 2013 and 2014 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $4.1 million for the audit period. Overpayments 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.