Audit finds UHC overcharged $4.4 million for patient care

(Photo: Advertiser file photo)

LAFAYETTE, La. (The Advertiser)– The U.S. Office of Inspector General’s audit reports says Lafayette General Medical Center received $4.4 million in Medicare overpayments for claims in 2013 and 2014.

The audit, which was completed in late April, said the hospital system did comply with Medicare billing requirements for 34 of 103 inpatient claims but did not fully comply with the remaining 69 filed claims.

“On the basis of our sample results, we estimated that the hospital received overpayments of at least $4.4 million for claims paid during 2013 and 2014,” the audit report’s summary said.

On Wednesday, Lafayette General Health issued a response to the report claiming that it disagrees “with over 85 percent of the OIG’s conclusions.”

“Lafayette General would like the public to know that these were not fraudulent claims,” the hospital system said. “Appropriate care was delivered to our patients and a bill was filed with Medicare. We are operating within the guidelines set-up by the government and there were zero cases of abuse within the system. In only a few instances, LGMC made clerical errors in attempting to navigate a complex coding system.”

The OID audit report recommends that LGHS refunds the Medicare program $4,126,732 in estimated overpayments and ensure that $287,257 that was refunded after the start of the review has been recovered by Medicare. The report also calls for LGHS to “strengthen controls” to ensure that it is fully complying with Medicare requirements.

Lafayette General’s statement on Wednesday went on to say that LGHS plans to appeal each claim and that the health care is system is one of many other health care providers that are in the process of appealing overpayment claims.

“A majority of the disputed Medicare claims center on whether they should have been billed in an inpatient or outpatient setting,” the statement said. “We assert that the guidelines for inpatient billing are vague and often unclear. These types of claims are billed based upon the medical judgment made by a physician at the time of treatment and the patient’s condition at that moment.”

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