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Medicare Compliance Review of Somerset Hospital for Calendar Years 2009 Through 2011

Somerset Hospital (the Hospital), located in Somerset, Pennsylvania, complied with Medicare billing requirements for 48 of the 126 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 78 claims, resulting in net overpayments totaling $313,000 for calendar years 2009 through 2011. 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 contain errors.

Filed under: Center for Medicare and Medicaid Services