CHA News Article

Hospitals Overpaid for Outpatient Services Provided to Inpatients of Other Hospitals
Contractors directed to recover overpayments

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has released the attached report finding Medicare overpayments to acute care hospitals for outpatient services provided to inpatients in other hospitals, including long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric hospitals and critical access hospitals. The OIG also determined that beneficiaries were inappropriately held responsible for deductibles and co-insurance payments.

Generally, outpatient services provided by an acute care hospital should be provided through an arrangement with the hospital where the patient is an inpatient, and Medicare should pay the inpatient facility as part of inpatient rate. The OIG recommends that the Centers for Medicare & Medicaid Services (CMS) direct contractors to recover the identified overpayments, instruct acute care providers to refund incorrectly collected payments and identify other incorrect payments. The OIG also recommended that CMS correct system edits to prevent overpayments and to educate acute care hospitals.