Review of Internal Control Procedures at Tenet Metrowest Healthcare System, LP (d/b/a Metrowest Medical Center) for the Administration of Epogen for Calendar Year 1999

EXECUTIVE SUMMARY:

This final report points out that in 19 of the 33 claims reviewed (58%) at Tenet MetroWest Healthcare System, LP (d/b/a MetroWest Medical Center), hereinafter referred to as Tenet, we found reconciliation inconsistencies between the number of units of EPOGEN (EPO) prescribed in the physician order, administered by the facility to the patient and billed to Medicare. The claims were submitted for services rendered during the period January 1, 1999 through December 31, 1999 that contained services for EPO equal to or greater than 90,000 billed and reimbursed units. The Tenet submitted 33 claims in this category and the total charge to Medicare was $125,126. We recommended that Tenet continue to strengthen its procedures to ensure the claims submitted for EPO are supported and billed in accordance with Medicare rules and regulations. Tenet officials stated that they will cooperate with the fiscal intermediary to effectuate any potential corrective action with respect to the claims identified in the Report.

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