LAFAYETTE, La. (KLFY)— Lafayette General responds to the audit report issued by the U.S. Office of Inspector General’s Reports saying LGMC received $4.4 million in Medicare overpayments for claims in 2013 and 2014.
“The OIG report does not question the quality of care or medical necessity of treatment provided by LGMC.”
Officials with Lafayette General tell News 10, that these were not fraudulent claims. Hospital officials say appropriate care was delivered to their patient 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.”
Lafayette General disagrees with the conclusions of the OIG and states that over 85% of the conclusions the hospital objects to.
“We continue to maintain that our claims were properly billed and will appeal each claim, one-by-one, until resolution is achieved. LGMC is not alone”
A spokesperson for the hospital told KLFY, that “many large medical centers throughout the country are in the process of appealing similar findings.”
A majority of the disputed Medicare claims center on whether they should have been billed in an inpatient or outpatient setting. According to a spokesperson, those types of claims are billed based upon the medical judgment of a physician at the time of treatment, and the patient’s condition at that moment.
The hospital tells News 10 that they fully support the medical judgment of their physicians in determining what is best for a patient at the time care is delivered.
Lafayette General says they expect the appeals process to take 2 to 4 years to complete.