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Audit (A-05-12-00080)

Medicare Compliance Review of University of Cincinnati Medical Center for Calendar Years 2010 and 2011

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University of Cincinnati Medical Center (the Hospital) complied with Medicare billing requirements for 101 of the 228 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 127 claims, resulting in net overpayments of $603,000 for calendar years (CYs) 2010 and 2011 (audit period). On the basis of our sample results, we estimated that the Hospital received net overpayments totaling at least $9.8 million for the audit period. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

We recommended that the Hospital (1) refund to the Medicare contractor $9.8 million (of which $603,000 was net overpayments identified in our sample) in estimated net overpayments for CYs 2010 and 2011 that it incorrectly billed and (2) strengthen controls to ensure full compliance with Medicare requirements. The Hospital disagreed with our first recommendation and discussed steps it had taken or planned to take to strengthen its internal controls to ensure compliance with Medicare billing requirements related to our second recommendation.

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