Baylor Cited For Medicare Overpayment

Baylor All Saints Medical Center
Baylor All Saints Medical Center

Baylor All Saints Medical Center has been overpaid for Medicare services by $371,952, a federal investigation has found.

During a Medicare compliance review for 2010 and 2011, released in late January, the Department of Health and Human Services Office of the Inspector General found that the hospital did not fully comply with Medicare billing requirements for 123 claims in 2010 and 2011, out of 244 reviewed. Specifically, 105 inpatient claims had billing errors, resulting in net overpayments of $369,080, and 18 outpatient claims had billing errors, resulting in net overpayments of $2,872. These errors occurred primarily, according to OIG, “because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.”

The OIG recommended that the Medicare money be repaid, and that the hospital “strengthen controls to ensure full compliance with Medicare requirements.”

In written comments to a draft version of the report, Baylor All Saints partially agreed with the first recommendation, the repayment of Medicare money. But hospital officials disagreed with the finding on 34 of the 182 selected inpatient claims incorrectly billed as inpatient.

“[Baylor All Saints] provided inpatient level of care services based on the physician order and the patients’ presenting condition,” officials wrote.

Officials will dispute the claims in question through the Medicare appeals process, and refund the remainder of the overpayments identified, documents indicate. The hospital will also strengthen its internal controls to ensure compliance with Medicare billing requirements.

“Through this routine audit and work with the Office of Inspector General, we have determined ways to continue to improve our processes,” Baylor officials said in an email. “Of course, as always, we fully intend to comply with Medicare requirements.”

Baylor All Saints, in Fort Worth, is a 525-bed full-service hospital. Medicare paid the hospital approximately $154 million for 12,334 inpatient and 42,163 outpatient claims for services during 2010 and 2011. The audit covered $2,870,949 in Medicare payments to the hospital for 244 claims that were selected as “potentially at risk for billing errors.”

Posted in Finance, Hospitals, News.
  • Tom Davis

    When I do the math, I find that Baylor’s processing error percentage is about .25%–that’s one-quarter of one percent–of its Medicare claims. That’s pretty good by any measure; human error would explain at least that much!

  • James

    For sure, no malice here. Your gonna get this no matter what. My question is how much did it cost to do an audit? My guess is the government lost money, no surprise.

  • Sharon

    Purposeful fraudulent billing is a coming occurrence at Baylor All Saints. The facility as a whole is greedy, unethical, and is going under fast for it.