Medicare Compliance Review of St. Vincent Healthcare for 2011 and 2012

St. Vincent Healthcare (the Hospital) (operating in Billings, Montana) complied with Medicare billing requirements for 191 of the 213 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 22 claims, resulting in overpayments of $267,000 for calendar years (CYs) 2011 and 2012 (20 claims) and CY 2010 (2 claims). Specifically, 13 outpatient claims had billing errors, resulting in overpayments of $206,000, and 9 inpatient claims had billing errors, resulting in overpayments of $61,000. 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.