Medicare Compliance Review of Nebraska Methodist Hospital for 2012 and 2013

Nebraska Methodist Hospital (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 119 of the 138 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 19 claims, resulting in net overpayments of $111,000 for calendar years 2012 and 2013. Specifically, 17 inpatient claims had billing errors, resulting in net overpayments of $86,000, and 2 outpatient claims had billing errors, resulting in overpayments of $25,000. 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.