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Medicare Compliance Review of Mobile Infirmary Medical Center

Mobile Infirmary Medical Center (the Hospital) complied with Medicare billing requirements for 87 of the 100 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 13 claims, resulting in net overpayments of $163,104.

On the basis of our sample results, we estimated that the Hospital received overpayments of at least $340,125 for the audit period.

We recommended that the Hospital refund to the Medicare contractor $340,125 in estimated overpayments for the audit period for claims that it incorrectly billed; exercise reasonable diligence to identify and return any additional similar overpayments received outside of our audit period, in accordance with the 60-day rule; and strengthen controls to ensure full compliance with Medicare requirements.

The Hospital did not agree with all of our findings and recommendations. Specifically, the Hospital disagreed that it incorrectly billed inpatient rehabilitation claims. In addition, the Hospital disagreed with our recommendation to identify and return any additional similar overpayments received outside of the audit period. We obtained independent medical review for all IRF claims in our sample. We provided the independent medical reviewers with all documentation necessary to sufficiently determine medical necessity and documentation requirements for the IRF claims, and our report reflects the results of that review. Based on the Hospital´┐Żs rebuttal and our internal review, we reduced the overpayment amount and associated recommendation in this report from the initial recommended recovery amount in our draft report.

Filed under: Center for Medicare and Medicaid Services