A hospital, according to a federal audit, has improperly billed Medicare for more than $23.6 million in services and called on them to refund the money.
Hospital is Appealing Decision
The Sunrise Hospital and Medical Center of Las Vegas will appeal the decision by the Office of the Inspector General for the U.S. Department of Health and Human Services. This would trigger a process that could literally take “several years,” CEO Todd Sklamberg said last Thursday.
Care to Patients
“OIG findings are strongly disagreeing with it. In fact, it is related to our inpatient rehab facility. Moreover, we believe that the care we provide to our patients is necessary and effective,” he said.
Hospital did not Comply with Medicare Billing Procedures
OIG’s office looked at 100 inpatient and outpatient claims. This is part of a routine audit. The hospital did not comply with Medicare billing procedures in 54 of the claims, according to the report. However, there were five reprocessing during the duration of the audit. Moreover, those claims have been accepting by the OIG. In fact, they were removing from the amount it wants Sunrise to repay.
Unnecessary Inpatient Visits
Sunrise billed Medicare for unnecessary inpatient visits, according to the report. Also, situations where the patient did not meet the standard for necessary inpatient care. This is an instance where “the ordering physician expects the patient to expect care for a period of time that crosses two midnights.”
Last month, when the report was released, it asked Sunrise to bolster its policies to comply with Medicare requirements. In fact, Sklamberg said Sunrise has gotten a preliminary version of the report. It has noted that it acknowledges numerous instances where the hospital and discusses the multiple occasions where the hospital disputes the audit’s data.
Sklamberg also emphasized that Sunrise’s inpatient program is the only one certificating by the Commission on Accreditation of Rehabilitation Facilities (CARF) in Southern Nevada.