The Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that the University of Miami Hospital (Hospital) received about $3.7 million in overpayments for the period of April 1, 2009 through December 31, 2010. The amount calculated by the OIG is the largest overpayment in the history of Medicare compliance reviews. The OIG arrived at that figure partly by extrapolating errors for short inpatient stays, although the OIG scrutinized six different risk areas in its Medicare Compliance Review. During its review, the OIG selected a stratified random sample of 200 inpatient claims out of a universe of 2,194 Medicare claims. Out of the 200 claims reviewed, the OIG found 68 errors. The OIG concluded that the Hospital overcharged Medicare by $524,009. The OIG recommended that the Hospital return approximately $3.7 million based on an extrapolation of errors. The Hospital disagreed with the recommendation and objected to the OIG’s decision to extrapolate the results from an audit sample.
The OIG Medicare compliance review of the Hospital is available at:
Department of Health and Human Services Office of Inspector General. “Medicare Compliance Review of University of Miami Hospital.” A-04-12-07033. 30 Sept. 2013.