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Audit (A-02-11-01022)

05-22-2012
Medicare Compliance Review of New York Downtown Hospital for the Period July 1, 2008, Through December 31, 2010

Executive Summary

New York Downtown Hospital (the Hospital) complied with Medicare billing requirements for 128 of the 186 claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for 58 selected inpatient and outpatient claims, resulting in overpayments totaling $423,978. Specifically, 22 inpatient claims had billing errors, resulting in overpayments totaling $423,978, and 36 outpatient claims had billing errors that did not result in any overpayments. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims and its staff did not fully understand the Medicare billing requirements.

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