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Feds demand millions in Medicare overpayment after audit

The United States Department of Health and Human Services (HHS) Office of Inspector General recently released its findings from an audit of an HCA Healthcare owned facility operating out of Las Vegas. According to their findings, the facility owes the feds millions.

What triggered the audit?

Various triggers can result in this type of an audit. One example involves a complaint. If the feds receive a complaint about potential errors, they may choose to move forward with an investigation that could include an audit. In this case, the audit was routine. This could occur to meet various federal obligations, such as to check for HIPAA compliance.

It is also important to note that this is not HCA Healthcare’s first time dealing with allegations of Medicare overpayments. In a past investigation, the government claimed to find evidence of abuse in the group’s practices from 1997 through 2003. Based on these findings, the DOJ accused the group of the “largest healthcare fraud case” in the country’s history. This led to an agreement where HCA Healthcare would pay the government over $1 billion.

How could the hospital system owe the feds millions?

The government claims the facility failed to comply with Medicare payment requirements. In one example, they claim the facility improperly billed for inpatient services. As a result, the feds claim the hospital system filed improper claims and received millions in overpayments from Medicare.

What does this mean for the system?

The feds are requiring the system pay back these funds and asking it to strengthen its policies to better ensure compliance in the future. Those who find themselves facing these types of allegations do not have to agree with the feds’ findings. In this case, the group is fighting back. They are challenging the findings from the audit, stating the care provided was “necessary and effective.” If they have documentation to back up this claim, they could successfully appeal the audit.