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Medicare Compliance Review of Rhode Island Hospital for Calendar Years 2010 and 2011

The Hospital complied with Medicare billing requirements for 148 of the 233 claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for selected inpatient and outpatient claims. Specifically, 85 claims had billing errors that resulted in overpayments totaling $214,000 for calendar years 2010 and 2011. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims and did not fully understand the Medicare billing requirements.