Medicare Compliance Review of Mount Sinai Hospital for 2012 and 2013

Mount Sinai Hospital (the Hospital) located in New York, New York, complied with Medicare billing requirements for 151 of the 261 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 110 claims for the audit period (calendar years 2012 and 2013). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $41.9 million for the audit period. 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.