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UCSD Hospital Overcharged Medicare, Federal Audit Finds

Auditors for the Inspector General of the United States Department of Health and Human Services have found that the UCSD Medical Center hospital overcharged the federal Medicare program a total of more than $350,000 on 99 of 210 claims sampled by investigators.

"The Hospital complied with Medicare billing requirements for 111 of the 210 inpatient and outpatient claims we reviewed," according to the audit report, dated yesterday.

"However, the Hospital did not fully comply with Medicare billing requirements for the remaining 99 claims, resulting in overpayments totaling $350,897 for [calendar years] 2008 and 2009.

"Specifically, 72 inpatient claims had billing errors, resulting in overpayments totaling $238,021, and 27 outpatient claims had billing errors, resulting in overpayments totaling $112,876."

The auditors went on say that, "These overpayments occurred primarily because the Hospital’s existing controls did not adequately prevent incorrect billing of these Medicare claims."

"We recommend that the Hospital: refund to the Medicare contractor $350,897, consisting of $238,021 in overpayments for the incorrectly billed inpatient claims and $112,876 in overpayments for the incorrectly billed outpatient claims, and strengthen controls to ensure full compliance with Medicare requirements. "

According to the report, Medicare paid the hospital about $277 million for 12,947 inpatient and 177,075 outpatient claims during 2008 and 2009.

In a January 21 letter of response to an earlier draft of the audit provided to the university, Kathleen Naughton, UCSD Medical Center's chief compliance and privacy officer, took issue with some of its conclusions, in particular the amount of the refunds sought, but conceded that much of report was correct, saying, "The University of California San Diego Medical Center (Hospital) generally agrees with the [Inspector General's] findings."

"The Hospital in conjunction with the Compliance Program, has and will continue to actively strengthen controls to prevent billing errors, to monitor adherence to billing requirements, and to promptly remedy identified deficiencies, particularly for the audited areas."

The auditors said their final report addressed the adjustments sought by Naughton.

According to a February 28 letter from the Inspector General's office to UCSD Medical Center chief financial officer Lori R. Donaldson, the university has 30 days to respond to the audit's recommendations, including those seeking a refund of the Medicare payments, after which the government will take final action in the case.

A hospital spokeswoman said this morning that the document is currently being reviewed by staff.

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Auditors for the Inspector General of the United States Department of Health and Human Services have found that the UCSD Medical Center hospital overcharged the federal Medicare program a total of more than $350,000 on 99 of 210 claims sampled by investigators.

"The Hospital complied with Medicare billing requirements for 111 of the 210 inpatient and outpatient claims we reviewed," according to the audit report, dated yesterday.

"However, the Hospital did not fully comply with Medicare billing requirements for the remaining 99 claims, resulting in overpayments totaling $350,897 for [calendar years] 2008 and 2009.

"Specifically, 72 inpatient claims had billing errors, resulting in overpayments totaling $238,021, and 27 outpatient claims had billing errors, resulting in overpayments totaling $112,876."

The auditors went on say that, "These overpayments occurred primarily because the Hospital’s existing controls did not adequately prevent incorrect billing of these Medicare claims."

"We recommend that the Hospital: refund to the Medicare contractor $350,897, consisting of $238,021 in overpayments for the incorrectly billed inpatient claims and $112,876 in overpayments for the incorrectly billed outpatient claims, and strengthen controls to ensure full compliance with Medicare requirements. "

According to the report, Medicare paid the hospital about $277 million for 12,947 inpatient and 177,075 outpatient claims during 2008 and 2009.

In a January 21 letter of response to an earlier draft of the audit provided to the university, Kathleen Naughton, UCSD Medical Center's chief compliance and privacy officer, took issue with some of its conclusions, in particular the amount of the refunds sought, but conceded that much of report was correct, saying, "The University of California San Diego Medical Center (Hospital) generally agrees with the [Inspector General's] findings."

"The Hospital in conjunction with the Compliance Program, has and will continue to actively strengthen controls to prevent billing errors, to monitor adherence to billing requirements, and to promptly remedy identified deficiencies, particularly for the audited areas."

The auditors said their final report addressed the adjustments sought by Naughton.

According to a February 28 letter from the Inspector General's office to UCSD Medical Center chief financial officer Lori R. Donaldson, the university has 30 days to respond to the audit's recommendations, including those seeking a refund of the Medicare payments, after which the government will take final action in the case.

A hospital spokeswoman said this morning that the document is currently being reviewed by staff.

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