An HHS audit of claims made by New York-Presbyterian Hospital found sufficient billing errors to conclude the the mammoth hospital on Manhattan's Upper West Side may have received more than $14.2 million in Medicare overpayments over two years.
An audit by HHS' Office of Inspector General released Thursday also blasted New York-Presbyterian for its inadequate Medicare billing controls, which led to the significant overpayments.
New York-Presbyterian disputed the OIG's findings, telling the watchdog its review misapplied Medicare requirements. The $14.2 million overpayment estimate was “improper and statistically unsound,” the hospital's parent system, New York-Presbyterian, said in a statement.
The OIG audit looked at 285 inpatient and outpatient claims submitted to Medicare in 2011 and 2012, and found that 123 of those did not fully comply with Medicare billing requirements. That led to more than $819,000 in overpayments. When OIG extrapolated that data, it determined the total Medicare overpayments could have topped $14.2 million.
Nearly half of the 102 improperly billed inpatient claims shouldn't have been billed as inpatient services in the first place, the OIG report said. A significant portion of the other improperly billed claims stemmed from services that had been included in other Medicare claims.
The New York hospital, which is a main teaching hospital for the Columbia University College of Physicians and Surgeons, disputed 91 of the alleged 123 overpayments in OIG's audit. It agreed 32 of the audited inpatient and outpatient claims resulted in incorrect billings.
New York-Presbyterian Hospital also maintained that the vast majority of the highlighted payments could no longer be recouped by the CMS since the statute of limitations had expired.
Still, New York-Presbyterian Hospital said it would work to strengthen its billing controls to comply with Medicare's requirements.
The hospital received $1.5 billion in Medicare payments during 2011 and 2012, the HHS OIG audit said.
