Medicare Compliance Review of Hoag Memorial Hospital Presbyterian for Calendar Years 2008 Through 2011

Hoag Memorial Hospital Presbyterian (the Hospital), located in Newport Beach, California, complied with Medicare billing requirements for 126 of the 249 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 123 claims, resulting in overpayments totaling $488,000 for calendar years 2008 through 2011. These overpayments occurred primarily because the Hospital's existing controls did not adequately prevent incorrect billing of these Medicare claims.