Medicare Compliance Review of Bergan Mercy Medical Center for 2013 and 2014

Bergan Mercy Medical Center (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 219 of the 224 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining five claims, resulting in overpayments of $70,000 for calendar years 2013 and 2014. Specifically, three outpatient claims had billing errors, resulting in overpayments of $63,000, and two inpatient 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.