Medicare Compliance Review of MedStar Washington Hospital Center

MedStar Washington Hospital Center (Washington Hospital), operating in the District of Columbia, complied with Medicare billing requirements for 138 of the 313 inpatient and outpatient claims we reviewed. However, Washington Hospital did not fully comply with Medicare billing requirements for the remaining 175 claims, resulting in net overpayments of $1 million for calendar years 2010 and 2011. Specifically, 80 inpatient claims had billing errors, resulting in net overpayments of $411,000, and 95 outpatient claims had billing errors, resulting in overpayments of $651,000. These errors occurred primarily because Washington Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.