Medicare Compliance Review of Community Hospital

Community Hospital (The Hospital), located in Munster, Indiana, complied with Medicare billing requirements for 84 of the 170 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 86 claims, all of which were inpatient, resulting in net overpayments of $1.3 million for calendar years 2015 and 2016. 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 $22 million for our audit period.