Medicare Compliance Review of Saint Michael's Medical Center for the Period January 1, 2009, Through June 30, 2011

Saint Michael's Medical Center (the Hospital) complied with Medicare billing requirements for 132 of the 230 claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 98 claims, resulting in overpayments totaling $492,000 during the period January 1, 2009, through June 30, 2011. Specifically, 71 inpatient claims had billing errors resulting in overpayments totaling $451,000, and 27 outpatient claims had billing errors resulting in overpayments totaling $41,000. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims, and its staff did not fully understand the Medicare billing requirements within the selected areas of risk.