Medicare Compliance Review of Ochsner Medical Center for the Period January 1, 2011, Through September 30, 2012

Ochsner Medical Center (the Hospital) (operating in New Orleans, Louisiana) complied with Medicare billing requirements for 107 of the 158 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 51 claims, resulting in overpayments of $396,000 during the period January 1, 2011 through September 30, 2012 (audit period). Specifically, 26 inpatient claims had billing errors, resulting in overpayments of $288,000, and 25 outpatient claims had billing errors, resulting in overpayments of $108,000. 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. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.6 million for the audit period.