Carolinas HealthCare overbilled Medicare, federal auditor finds

Carolinas HealthCare overbilled Medicare, federal auditor finds

CHARLOTTE, NC (Deon Roberts/The Charlotte Observer) - Carolinas HealthCare System overbilled the federal Medicare program an estimated $1.7 million for patients treated at two hospitals near uptown, according to a new federal audit.

The findings on Carolinas Medical Center and CMC-Mercy are part of a report this month from the Department of Health and Human Service's Office of Inspector General, which routinely conducts similar reviews of U.S. hospitals.

Charlotte-based Carolinas HealthCare, the region's dominant hospital system, said it plans to appeal the findings.

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According to the report, the two hospitals lacked adequate controls to prevent incorrect billings, the report said. The audit, based on a random sample of 240 Medicare payments in 2014 and 2015, found the hospitals didn't fully comply with the program's billing requirements for 83 claims, or about 34 percent.

As a result, Medicare – a key health insurance program for older Americans and those with disabilities – was overbilled $331,831, the report said. Errors resulted in part from some claims being incorrectly coded, according to the report.

Based on its findings from the sample, the inspector general said the two hospitals received at least $1,659,619 in overpayments during the two-year period. The inspector general has recommended the hospitals refund that amount to Medicare.

In its a statement, Carolinas HealthCare said:

"While this audit identified alleged inpatient coding discrepancies in only 5 percent of audited payments, we disagree with many of the findings as well as the methods used to arrive at the ultimate conclusions."

The hospital system added: "Carolinas HealthCare System prides itself on its strong compliance program – one that, in fact, has been acknowledged by the OIG. Our team works diligently to ensure accurate billing and coding for all claims filed and we have developed comprehensive policies, procedures and education both to prevent discrepancies and continually improve our programs."

In the report, the inspector general's office acknowledged Carolinas HealthCare disputes some of the findings, but the office said it maintains that the hospitals incorrectly billed Medicare.