The United States Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently reported that a number of hospitals received millions in Medicare overpayments. The OIG stated one of these hospitals was located within Northwell Health’s Network in Staten Island and received over $11 million in Medicare overpayments due to billing errors. Of the reviewed claims, the agency has accused the hospital of failure to comply with over 33% of the inpatient and outpatient claim requirements.
The feds also reviewed 100 inpatient and outpatient claims for a New Jersey hospital and states they failed to comply with Medicare billing requirements in 40 of those claims. The OIG claims these failures led to at least $4.8 million in Medicare overpayments.
The feds have asked the hospitals to repay these funds and strengthen its compliance efforts.
What options are available when accused of a Medicare overpayment?
Those who receive a demand for repayment like the hospitals noted above generally have three options:
- Pay the bill. The feds will accept an outright payment, but also offer recoupment options for repayment. These include immediate recouperation or smaller portions over a set period of time.
- Submit a rebuttal. You can submit a rebuttal, but this must generally be done within 15 days of getting the demand letter. This rebuttal should include evidence of why the recoupment should not occur. The rebuttal does not necessarily stop the government’s recoupment efforts.
- Appeal the decision. You can also appeal the government’s decision. This process goes through many levels: redetermination, reconsideration, hearing before an Administrative Law Judge or official review, review by Medicare Appeals Council and a Judicial Review in U.S. District Court.
The key takeaway: you can fight back. You do not have to meet the government’s demands for payment. However, it is important to note that the government abides by a strict timeline for these cases. A failure to act within a reasonable timeframe can mean you lose the change to challenge the government’s claim.