Federal Reports

Hennepin County Medical Center (the Hospital) complied with Medicare billing requirements for 134 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 77 claims, resulting in overpayments of $537,000 for CYs 2012 and 2013 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $1.6 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.

Nevada did not allocate costs for establishing a health insurance marketplace to its establishment grants in accordance with Federal requirements. As a result, Nevada misallocated $893,000 in costs to the establishment grants instead of the Medicaid program over 3 years.