Medicare Compliance Review of University of Miami Hospital

University of Miami Hospital (the Hospital), located in Miami, Florida, complied with Medicare billing requirements for the majority of the claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for 68 inpatient claims resulting in overpayments totaling $524,000. On the basis of our stratified random sample results, we estimated that the Hospital received overpayments of about $3.7 million for the period April 1, 2009, through December 31, 2010. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of these Medicare claims.

We recommended that the Hospital (1) refund the Medicare program $3.7 million in estimated overpayments for the audit period that it incorrectly billed for inpatient claims and (2) strengthen controls to ensure full compliance with Medicare requirements. The Hospital disagreed with our findings and recommendations.