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Audit (A-07-12-05031)

09-05-2013
Medicare Compliance Review of Sanford Medical Center in Fargo for Calendar Years 2010 and 2011

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Summary

Sanford Medical Center in Fargo (the Hospital) (operating in North Dakota) complied with Medicare billing requirements for 226 of the 252 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 26 claims, resulting in overpayments of $65,000 for calendar years (CYs) 2010 and 2011 (24 claims) and CY 2009 (2 claims). Specifically, 11 inpatient claims had billing errors, resulting in overpayments of $51,000, and 15 outpatient claims had billing errors, resulting in overpayments of $14,000. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

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