Medicare Compliance Review of Avera McKennan Hospital for 2010 and 2011

Avera McKennan Hospital (the Hospital) (operating in Sioux Falls, South Dakota) complied with Medicare billing requirements for 227 of the 262 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 35 claims, resulting in overpayments of $174,000 for 2010 and 2011. Specifically, 29 inpatient claims had billing errors, resulting in overpayments of $167,000, and 6 outpatient claims had billing errors, resulting in overpayments of $7,000. 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.