During the time period reviewed, Noridian made 405 high-dollar (of $200,000 or more) Medicare payments to hospital for inpatient services, of which 306 were found to be appropriate. The remaining 109 were due to hospitals inaccurately reporting the number of billing units of service, incorrect procedure codes and excessive charges that resulted in inappropriate outlier payments, according to the audit. Most hospitals attributed these to billing or clerical errors.
In the audit, the OIG recommends that Noridian recover the remaining $1.9 million, use the results of the audit for provider education purposes and consider implementing controls to identify and review all high-dollar payments for inpatient services.
Read the OIG’s summary of the Noridian Medicare payment audit.
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