Federal Reports

The University of Tennessee Medical Center (the Hospital) complied with Medicare billing requirements for 219 of the 236 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 17 claims, resulting in overpayments of $42,000. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims within the selected risk areas that contained errors.

A Florida physical therapy practice (the Therapy Practice), located in Boca Raton, Florida, properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days that we sampled. However, the Therapy Practice improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days. These deficiencies occurred because the Therapy Practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements.

The Office of Inspector General (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. The reviews assess the Units' adherence to the 12 MFCU performance standards and its compliance with applicable Federal statutes and regulations.