OHSU Fined $2.4 Million by CMS

The hospital, which has refunded the overpayments, resulted from the lack of adequate controls when billing Medicare claims.

An audit conducted by the Office of Inspector General has found that Oregon Health & Science University did not fully comply with Medicare billing requirements from 2010 through 2012 which resulted in overpayments of $2.4 million.

Medicare paid OHSU approximately $504 million for 24,249 inpatient and 390,167 outpatient claims during the two-year time period. However, the audit only covered $3.5 million for 113 claims of which  102 were inpatient and 11 outpatient claims. They were selected after being considered potentially at risk for billing errors.

The federal agency found that 57 of those 113 claims were incorrectly billed because OHSU lacked adequate controls in the selected risk areas. Of those claims, 21 involved bone marrow procedures and peripheral blood stem cell transplantation that required a less intensive level of care. OHSU officials attributed the remaining 36 claims to patient admission errors.

OHSU has agreed with the findings, according to Tamara Hargens-Bradley, associate director of media relations and has “refunded the overpayment for the incorrectly billed claims and strengthened controls to ensure full compliance with Medicare requirements."

In a letter to the Department of Health and Human Services, Diana Gernhart, senior vice president and chief financial officer, told the agency that “we have educated case management staff and providers regarding proper documentation and admission status classification requirement for those procedures.”

She added that OHSU has formed a partnership with a nationally respected external physician advisor company to “have better and timely access to physician experts in the field of medical necessity, admission order requirements and admission status classification.” When patients do not pass screening criteria for admission to the hospital, they are referred to these external physician advisors for additional medical review.

“These actions have improved our processes and efforts to accurately classify admission status and submit accurate claims,” she concluded.    

Field work to review these claims was conducted at OHSU from September 2013 to June 2014.

Diane can be reached at [email protected]

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