HHS' inspector general's office said last week that it has settled 925 of an anticipated 4,660 audits of hospitals for improper billing of outpatient services, recovering more than $22 million in Medicare funds.
The inspector general's office boasted of its results in its semi-annual report to Congress on its efforts to enforce rules and regulations that protect Medicare and Medicaid.
The audits to which HHS is referring began in December 1994 and focus on diagnostic tests that were performed by hospitals shortly before patients were admitted for care. If the tests were taken within 72 hours of admission, the government says they're already paid for as part of Medicare's diagnosis-related group payments to hospitals. Hospitals that bill separately for the tests are submitting fraudulent Medicare claims, the government contends.
Hospitals in eight states have gone through audits and are in the process of paying settlements. The states are Florida, Illinois, Indiana, Louisiana, Mississippi, Missouri, New York and Pennsylvania, where the investigation began.
Audits are pending in three states: Georgia, New Jersey and North Carolina. Next up on the audit list are hospitals in California and Texas.
When all the audits are completed, the inspector general's office said it expects to have collected as much as $110 million from hospitals.
The report also updated Congress on the progress of its ongoing investigation of hospital Medicare billing for certain laboratory tests (See related story, p. 33).
For the fiscal year ended Sept. 30, the inspector general reported 151 convictions for fraud relating to federal health programs and nearly 2,000 administrative sanctions against healthcare providers.
The agency's most ambitious ongoing program, Operation Restore Trust, has 270 pending cases, it said. In addition, 16 skilled-nursing facilities are currently being audited. Operation Restore Trust, initiated in 1995, is a coordinated effort between state and federal investigators in California, Florida, Illinois, New York and Texas. Those states account for more than 40% of all Medicare and Medicaid costs.
The report also reveals that in the six-month period ended Sept. 30, 793 individuals and entities were excluded from the Medicare program and more than $94 million was collected from providers in civil suits relating to Medicare and Medicaid.