Medicare Compliance Review of Hennepin County Medical Center for 2012 and 2013

Hennepin County Medical Center (the Hospital) complied with Medicare billing requirements for 134 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 77 claims, resulting in overpayments of $537,000 for CYs 2012 and 2013 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $1.6 million for the audit period. Overpayments 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.

We recommended that the Hospital (1) refund to the Medicare contractor $1.6 million (of which $537,000 was overpayments identified in our sample) in estimated overpayments for incorrectly billed services, and (2) strengthen controls to ensure full compliance with Medicare requirements. The Hospital generally agreed with our first recommendation and discussed steps it had taken or planned to take regarding our second recommendation.