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Audit (A-09-13-02052)

Review of Outpatient Surgeries Billed by Tulare Regional Medical Center

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Tulare Regional Medical Center (the Hospital), located in Tulare, California, did not comply with Medicare billing requirements for all 10 of the outpatient surgery claims that we reviewed, resulting in overpayments of approximately $179,000 for calendar years 2011 and 2012. Specifically, the Hospital billed Medicare with an incorrect number of units for cataract and hip surgeries. These errors occurred because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare for service units on outpatient surgery claims.

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