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IA: University of Iowa Hospital dinged for Medicare overpayments

11/20/2012

DES MOINES – Officials at the University of Iowa Hospital submitted bills to Medicare riddled with errors, sought reimbursement for treatments that were never given and overstated the number of procedures performed, according to a newly released report from the U.S. Inspector General’s Office.

Federal investigators reviewed 321 outpatient and 77 inpatient claims from 2009 and 2010 that totaled $5.2 million. Officials found 274 of the 398 claims did not fully comply with Medicare billing requirements, resulting in $826,104 in overpayments to the hospital, the report showed.

Federal officials ding University of Iowa Hospital in financial review.

The cases represent only a sampling of the hospital’s nearly 547,000 claims totaling $659 million during that two-year time span.

The review was part of federal officials’ ongoing effort to review payments for claims that they have found to be more at risk for noncompliance. They examined eight specific areas, including outpatient claims exceeding $25,000, billing for Lupron injections and claims paid in excess of charges. Additionally, cases of same day discharge and readmission and psychiatric and post-acute transfers were audited.

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Tom Moore, spokesman for the university, said in an e-mail Tuesday the hospital is working to implement the inspector general’s recommendations.

University officials expanded on that response in a letter to the inspector general’s office, in which they said they had strengthened internal controls, provided staff with additional training and hired more employees to prevent future problems.

“The University of Iowa Hospitals and Clinics takes its obligation to bill correctly very seriously and has taken several steps to strengthen internal processes to ensure compliance with Medicare requirements,” the University’s Assistant Vice President for Compliance and Accreditation Deborah Thoman wrote in her response to the inspector general’s office.

Thoman, for the most part, agreed with the report’s findings, but disputed issues involving Lupron, a drug used for some cancers. Previous audits involving the drug failed to turn up findings and employees correctly coded the procedures according to the guidance they had at the time from the U.S. Department of Health and Human Services, she wrote in her response.

Federal auditors, however, maintained their finding that 237 Lupron claims were incorrectly coded, while another four lacked evidence to show patients actually received the treatment, according to the report.

They have requested the hospital refund the $566,180 related to the Lupron claims, as well as the $259,924 from other incorrect claims. One of those included an overstatement of procedures, in which 40 were performed but 400 were reported, resulting in an overpayment of $2,707. Another involved a coding error that was fixed and then deleted that added another $4,637 to their tally. Human error accounted for another $41,293 in inappropriate Medicare payments, the report showed.

“University of Iowa Health Care is committed to providing patient-focused health care available to every person in an environment devoted to innovative care, excellent service, and exceptional outcomes,” Thoman wrote. “We are committed to continued compliance with Medicare program regulations.”

Contact Sheena Dooley at dooley@iowawatchdog.org.

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