Evanston, Ill.-based NorthShore University HealthSystem overcharged Medicare at least $4.1 million over two years, according to HHS' Office of Inspector General.
A review by the OIG of NorthShore's Medicare claims in 2013 and 2014 found the four-hospital system incorrectly billed for intensive inpatient rehabilitation therapy that was found to not comply with billing requirements. That could mean not enough documentation was provided or the patients were not eligible for the services.
The OIG examined a random sample of 190 claims and found NorthShore didn't fully comply with billing requirements for 93 of those claims, resulting in the overpayments.
NorthShore incorrectly billed Medicare for 46 inpatient claims that totaled $496,366. The system also incorrectly charged Medicare $128,272 for its outpatient services.
The OIG recommended NorthShore refund Medicare the $4.1 million. The agency added that the system should identify and return any additional similar overpayments outside the audit period to the CMS.
NorthShore disputed that it didn't correctly bill 58 of the 93 claims determined by the OIG.
In a statement, NorthShore said, “We respectfully disagree with several of OIG's findings. Further, OIG never questioned the quality of care NorthShore provided these patients and deemed our services medically necessary. Our physicians use standardized care protocols to evaluate and support what's in the best interest of their patients. We believe OIG's audit process is flawed and misleading, resulting in a highly excessive repayment amount.”
NorthShore will appeal the OIG's findings.
In total, Medicare reimbursed NorthShore approximately $567 million for inpatient and outpatient claims in 2013 and 2014.