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Audit (A-01-10-00521)

03-02-2011
Medicare Compliance Review of South Shore Hospital for Calendar Years 2008 and 2009

Executive Summary

South Shore Hospital (the Hospital) did not fully comply with Medicare billing requirements for selected inpatient and outpatient claims. Specifically, of 389 sampled claims, 249 claims had billing or coding errors, resulting in overpayments totaling approximately $341,000 for CYs 2008 and 2009. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing and coding of Medicare claims and did not fully understand the Medicare billing requirements.

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