The hospital, however, questions the methodology that yielded the figure, echoing concerns of other hospitals that have faced similar reviews.
“OIG's report in no way challenges the quality and medical necessity of the care provided,” Northwestern said in a statement. “Rather, OIG concluded that most of these errors were because the claims should have been billed in an outpatient setting rather than an inpatient setting.
Northwestern Memorial intends to appeal these findings, as it is our belief that OIG's claims review process and statistical methodologies are flawed, resulting in a grossly overstated repayment amount.”
The OIG audited 171 sample inpatient and outpatient claims submitted in 2011 and 2012, with payments totaling nearly $1.5 million. The OIG found that Northwestern did not fully comply with Medicare requirements for 85 of the claims, resulting in overpayments to the hospital totaling $272,181. The agency then extrapolated those results to estimate that the hospital was overpaid by $6.4 million in 2011 and 2012.