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Audit (A-02-12-01026)

Medicare Compliance Review of Hospital Español Auxilio Mutuo De Puerto Rico, Inc., For Calendar Years 2010 and 2011

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Hospital Español Auxilio Mutuo de Puerto Rico, Inc. (Auxilio) complied with Medicare billing requirements for 745 of the 899 claims we reviewed. However, Auxilio did not fully comply with Medicare billing requirements for the remaining 154 claims, resulting in overpayments of $43,000 for calendar years 2010 and 2011. Specifically, 3 inpatient claims had billing errors resulting in overpayments of $10,000, and 151 outpatient claims had billing errors resulting in overpayments of $33,000. These 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 within the selected risk areas that contained errors.

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