Fletcher Allen Health Care Did Not Always Bill Correctly for Evaluation and Management Services Related to Eye Injection Procedures

05-21-2012 | Audit (A-01-11-00515) | Complete Report

Fletcher Allen Health Care (the Hospital), located in Burlington, Vermont, and its physicians complied with Medicare requirements for 15 of the 100 Evaluation and Management (E&M) services that we sampled. However, the Hospital incorrectly billed for the remaining 85 services, resulting in overpayments totaling $8,100. Based on these sample results, we estimated that the Hospital and its physicians received overpayments totaling $211,000 for calendar years 2008 through 2010. Overpayments occurred because the Hospital had inadequate billing system controls over billing E&M services related to outpatient eye injection procedures, and the Hospital's physicians, who performed the eye injection procedures, did not fully understand the Medicare requirements for separately billable E&M services.