Medicare Compliance Review of Nebraska Medical Center for Calendar Years 2010 and 2011

Nebraska Medical Center (the Hospital) complied with Medicare billing requirements for 151 of the 185 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 34 claims, resulting in overpayments of $320,000 for calendar years (CYs) 2010 and 2011 (27 claims) and CY 2009 (7 claims). Specifically, 12 outpatient claims had billing errors, resulting in overpayments of $170,000, and 22 inpatient claims had billing errors, resulting in overpayments of $150,000. 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.