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Audit (A-07-11-01098)

Medicare Compliance Review of St. John's Hospital for Calendar Years 2008 and 2009

Executive Summary

St. John's Hospital (the Hospital) complied with Medicare billing requirements for 166 of the 224 claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for selected inpatient and outpatient claims. Specifically, of the 224 sampled claims, 58 claims had errors, resulting in net overpayments totaling $420,000 for calendar years 2008 through 2010. These errors occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims and did not fully understand Medicare billing requirements.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201