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Medicare Compliance Review of St. Elizabeth's Medical Center for Calendar Years 2010 and 2011

St. Elizabeth's Medical Center (St. Elizabeth's) (operating in Brighton, MA) complied with Medicare billing requirements for 57 of the 282 inpatient and outpatient claims we reviewed. However, St. Elizabeth's did not fully comply with Medicare billing requirements for the remaining 225 claims, resulting in net overpayments of approximately $1.2 million for calendar years 2010 and 2011. Overpayments occurred primarily because St. Elizabeth's did not have adequate controls to prevent incorrect billing of Medicare claims within the selected risk areas that contained errors.