Medicare Compliance Review of Baton Rouge General Medical Center for Calendar Years 2009 and 2010

The Hospital complied with Medicare billing requirements for 125 of the 173 sampled inpatient and outpatient claims we reviewed. However, Baton Rouge General Medical Center (the Hospital) did not fully comply with Medicare billing requirements for the remaining 48 claims, resulting in overpayments totaling $373,000 for calendar years 2009 and 2010. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims, relied on physicians with varying levels of knowledge regarding level-of-care decisions, and did not fully understand the Medicare billing requirements.