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Audits Inpatient Billing

King & Spalding

OIG Audit Finds Medicare Overpaid Hospitals an Estimated $79 Million for Enrollees Who Had Received Mechanical Ventilation

King & Spalding on

On August 12, 2024, OIG announced the results of an audit of payments made to hospitals for inpatient claims with the Medicare Severity Diagnosis-Related Groups (MS-DRGs) that require ninety-six hours of consecutive...more

King & Spalding

OIG Hospital Compliance Program Audit Claims $22 Million in Extrapolated Overpayments

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A recent report issued by OIG finding an Indiana community hospital owed over $22 million in extrapolated overpayments carries some important lessons for hospitals audited under OIG’s hospital compliance program. As described...more

Bricker Graydon LLP

Hospice news update

Bricker Graydon LLP on

Hospice audits - In late 2017, the Centers for Medicare and Medicaid Services (CMS) expanded its targeted probe and educate (TPE) audit program to include hospices....more

Baker Donelson

OIG Hospital Compliance Audits: Is Your Number Up? Are You Ready?

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In its Work Plan for Fiscal Year 2012, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) announced it would begin reviews of Medicare payments to hospitals to determine compliance...more

Sheppard Mullin Richter & Hampton LLP

Medicare Hospital Compliance Reviews are Legal and Sound, According to OIG

The Office of Inspector General for the Department of Health and Human Services (OIG) recently defended its practices pertaining to hospital compliance reviews in a published response to a letter from the American Hospital...more

Faegre Drinker Biddle & Reath LLP

D.C. Circuit Declines Hospitals’ Plea for Relief from CMS Catch-22

Here’s how the catch works. A hospital admits and treats a Medicare patient who needs care. The hospital bills Medicare and gets paid. Later—usually much later—a RAC auditor rules that the patient needed only outpatient care...more

Baker Donelson

CMS Issues Additional Guidance Related to 2-Midnight Rule

Baker Donelson on

Earlier this month, CMS posted three new documents related to the 2-midnight rule for inpatient admissions on its webpage for inpatient hospital reviews: new FAQs, as well as CMS directions for selecting hospital claims for...more

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