California Hospitals Overbilled Medicare by $367M in 2012
Hospitals and providers in California overcharged Medicare by about $367 million in 2012, according to an audit report released by CMS, the San Francisco Business Times' "Bay Area BizTalk" reports (Rauber, "Bay Area BizTalk," San Francisco Business Times, 4/7).
Details of Report
Nationally, the new report found that hospitals and providers in 2012 overcharged Medicare on more than 1.2 million claims totaling $2.4 billion, including:
- $2.3 billion in overpayments; and
- $109.4 million in underpayments (Recovery Auditing report, 3/25).
After accounting for costs, CMS was able to recoup $1.9 billion for the Medicare trust fund.
California had the highest amount of overbilling, at $366.95 million. After California, New York had the next-highest overbillings, at $138.5 million ("Bay Area BizTalk," San Francisco Business Times, 4/7).
According to the report, more than 90% of overcharges nationwide were from inpatient hospital claims. The most common improper payments were for services that:
- Did not meet Medicare's criteria for coverage and medical necessity;
- Were incorrectly coded; and
- Did not include appropriate supporting documentation (Recovery Auditing report, 3/25).