Medicare Compliance Review of Stormont-Vail Regional Health Center for 2011 and 2012

Stormont-Vail Regional Health Center (the Hospital) (operating in Topeka, Kansas) complied with Medicare billing requirements for 183 of the 196 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 13 claims, resulting in overpayments of $111,000 for calendar years (CYs) 2011 and 2012 (9 claims) and CY 2010 (4 claims). Specifically, seven outpatient claims had billing errors, resulting in overpayments of $66,000, and six inpatient claims had billing errors, resulting in overpayments of $45,000. 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.