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Audit (A-07-12-05028)

11-19-2013
Medicare Compliance Review of Mercy Medical Center in Des Moines for Calendar Years 2009 and 2010

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Summary

Mercy Medical Center in Des Moines (the Hospital) (operating in Iowa) complied with Medicare billing requirements for 466 of the 557 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 91 claims, resulting in overpayments of $573,000 for calendar years (CYs) 2009 and 2010 (77 claims) and CYs 2008 and 2011 (14 claims). Specifically, 35 outpatient claims had billing errors, resulting in overpayments of $391,000, and 56 inpatient claims had billing errors, resulting in overpayments of $182,000. These errors 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.

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