Medicare Compliance Review of Moses H. Cone Memorial Hospital for 2012

Moses H. Cone Memorial Hospital (the Hospital), located in Greensboro, North Carolina, complied with Medicare billing requirements for 152 of the 225 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 73 claims, resulting in net overpayments of approximately $458,000. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.8 million for the audit period. 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.