From 2016 to 2021, the audit found that Medicare inappropriately paid acute-care hospitals $39.3 million for outpatient services they provided to patients who were inpatients of other facilities.
Before May 2019, the system edits were not working correctly. After they were updated, only $3.4 million of the $39.3 million was inappropriately paid from June 2019 to December 2021.
A prior audit found that from 2013 to 2016, Medicare inappropriately paid acute-care hospitals $51.6 million for the outpatient services.
The OIG recommended that CMS direct Medicare contractors to recover as much of the $39.3 million dollars as possible within the four-year claim reopening period.
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