Federal Audit asserts Vidant received $1.4 Medicare Overpayment | Eastern North Carolina Now

    A recent Audit Report by the Department of Health and Human Services, Office of Inspector General (OIG) Office of Audit Services found that " Incorrectly Billed Inpatient Claims With Severe Malnutrition, resulting in overpayments of approximately $1.4 million over 2 and a half years". (http://oig.hhs.gov)

    Vidant Medical Center was included in a nationwide audit on the use of specific diagnostic codes (261 and 262) which, when added to a Medicare claim, usually results in a higher Medicare payment. From 2011 through 2014, the Centers for Medicare and Medicaid Services (CMS) reimbursed hospitals nationwide over $20 billion for Medicare claims that included diagnosis codes 261 or 262.

    Upon a review of 941 claims submitted by Vidant from January 1, 2013 through June 30, 2015 that used the codes 261 or 262, the OIG determined that Vidant Medical Center received $16,693,564 in Medicare payments. After reviewing a random sample of 100 claims, Vidant Medical Center was found to be noncompliant in 89 claims, resulting in a Medicare overpayment of an estimated $1,403,132 for that audit period.

    The OIG recommended that the Hospital:

   •  Refund Medicare $1,403,132

   •  Identify and return any additional overpayments outside the Audit period

   •  Strengthen controls to ensure full compliance with Medicare billing requirements.

    In response to the 12 page OIG report, Vidant Health Office of Audit and Compliance responded emphatically in a 17 page letter voicing their disagreements and non-concurrence with the OIG findings and recommendations .

    Vidant pointed out that:

   •  the OIG findings and report is merely a recommendation to CMS and they should not be adopted.

   •  the OIG identified overpayments did not occur in 78 of the 89 cases.

   •  the OIG's "stated rational" for the audit is" based upon a faulty premise".

    Vidant was not satisfied with how the OIG audit contractors conducted the process, claiming the extreme difference in Connolly and Vidant Medical Center's findings versus the OIG audit findings, suggests that there is a distinct difference in the level of proficiency and expertise of the OIG audit contractors compared to the Vidant Medical Center coders and the Connolly auditors".

    Vidant Medical Center's request for a meeting to discuss the OIG report findings was denied. If the OIG audit is not changed, Vidant Medical Center will most likely take advantage of the appeal rights afforded under the Medicare Program.

    SOURCE: DHHS OIG Office of Audit Services Report #A-03-15-00011 released January, 2017 Vidant Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition