Medicare Compliance Review of UPMC Presbyterian Shadyside for Calendar Years 2008 Through 2011

UPMC Presbyterian Shadyside (Presbyterian Shadyside), located at two campuses in Pittsburgh, Pennsylvania, complied with Medicare billing requirements for 125 of the 239 inpatient and outpatient claims we reviewed. However, Presbyterian Shadyside did not fully comply with Medicare billing requirements for 1 claim that did not result in an overpayment and 113 claims that resulted in overpayments of $796,000 for calendar years 2008 through 2011. These errors occurred primarily because Presbyterian Shadyside did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.