Medicare claims JFK Medical Center overbilled

A federal audit of JFK Medical Center in Atlantis found that it overbilled Medicare by $4.4 million.

The 460-bed hospital, part of HCA (NYSE: HCA), had its 2009 and 2010 Medicare billings reviewed by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG), which released the report Wednesday. It recommended that the government attempt to recoup the money. The hospital is contesting the findings.

The auditors selected a $25.2 million portion of potentially erroneous claims out of $208 million in Medicare claims filed by the hospital for those years. Of that, 200 claims for $1.32 million were closely examined as a random sample.

While the OIG stated that JFK met Medicare billing requirements for the majority of its claims, it did not comply for 70 inpatient claims, totaling $293,869, out of the sample group that was examined. The most common error was billing claims as inpatient when they should have been considered outpatient observation stays, which have a lower reimbursement rate. In some cases, the wrong diagnosis groups were assigned to the claims.

The OIG extrapolated those findings to the $1.32 million sample size – assuming the same ratio of claims were overbilled – and declared that the hospital owes $4.4 million.

“Overpayments occurred primarily because the hospital did not have adequate controls to prevent incorrect billings of Medicare claims within the selected risk areas that contained errors,” the OIG stated in its study.

RELATED CONTENT: UM hospital owes $3.7M in overbilled Medicare, feds say

In its response, JFK said the government should be barred from recovering the alleged overpayments from 2009 because they are more than three years old, which is the deadline for such action. It also contested that 39 of those 70 inpatient claims were overbilled. In many of these cases, the patients’ physicians ordered that they be admitted to the hospital, and JFK simply followed their instructions, the hospital stated.

In addition, JFK said it’s not fair to extrapolate the alleged errors found to the larger group of claims to inflate the overbilling findings.

“Such extrapolation is erroneous as a matter of law, statistical integrity and fundamental fairness,” JFK stated in its official response to the OIG.

JFK added that it would strengthen its Medicare billing compliance.

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Alabama Pain Center undergoing months-long audit to close Nov. 15 unless Medicare payments resume

The Alabama Pain Center on 600 Whitesport Drive. S.W. in Huntsville. (Lucy Berry | lberry@al.com)

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By Lucy Berry | lberry@al.com 
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on October 14, 2013 at 6:34 PM, updated October 14, 2013 at 6:51 PM

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HUNTSVILLE, Alabama – The suspension of Medicare payments in late August and a dwindling supply of financial reserves will force the Alabama Pain Center to close its doors Nov. 15 unless payments resume, the clinic announced late Monday afternoon.
The Alabama Pain Center, which operates clinics on 600 Whitesport Drive. S.W. in Huntsville and 1701 Main Ave. S.W. in Cullman, plans to meet with patients and their families from 6-8 p.m. Tuesday at Trinity United Methodist Church to discuss anongoing audit of their Medicare accounts by AdvanceMed, a Zone Program Integrity Contractor.
Since January, AdvanceMed has conducted an audit of the pain clinic. Officials were informed in late August that all Medicare payments to the clinic would be suspended while the review continued. Despite presenting evidence that "the clinic has been adhering closely to all appropriate guidelines provided to them by CMS," officials said the outside contractor conducting the audit on behalf of CMS/Medicare chose to stop payments anyway.
The Alabama Pain Center, which receives about 80 percent of its total revenue from Medicare, filed a rebuttal of the auditor's decision to suspend payments in September. The clinic learned last week that CMS/Medicare dropped all but one claim against the pain center but did not lift AdvanceMed's order to stop Medicare payments.
Dr. Dean Willis, chief medical officer and founder of the Alabama Pain Center, said he will continue to appeal the decision, but that process could take more than a year. The Alabama Pain Center, which serves more than 2,700 patients and employs 124 staff members, only has enough reserves to continue operating through November.
"We are bitterly disappointed that this action by CMS and AdvanceMed will force our clinic to close resulting in the inability for our patient's (sic) to receive the care they need," he said in a written statement. "For over 20 years, the one goal of the Alabama Pain Center has been to provide the highest quality state of the art treatments for the thousands of patients who have come to us for help from across our region. It is heartbreaking that this action will no longer allow us to achieve that goal."
Attempts to reach NCI, which acquired AdvanceMed in 2011, on Monday afternoon were unsuccessful. Serving CMS/Medicare since 1999, AdvanceMed is an integrity services provider based in Virginia that works to detect and prevent fraud, waste and abuse in healthcare programs in 38 states.
Willis said Alabama Pain Center patients and staff will continue to work with the Congressional Delegation to stop this decision, and officials are preparing an appeal "based on the danger to life and health that closure of this practice presents to patients." On Tuesday, the Medical Association of the State of Alabama will meet to discuss what options are available to keep the pain center open.
Approximately 322 patients who have received customized spinal medication through the clinic's implantable pain pump therapies will be most affected by the closure.
"They depend on it in order to perform normal daily activities like walk, stand, sit and smile," an announcement said. "These patients are among the most severe of chronic pain sufferers. Each of them have received care from multiple other physician specialists and have tried many other pain therapies, including pain medications, pain blocks, counseling, physical therapy and surgery with no relief."
Willis said the impending closure of the clinic because of a "misguided, bureaucratic review like this" has been upsetting to his staff.
"It is still my hope and my prayer that someone at CMS will put the needs of these patients first," he said. "These patients truly are our family and it is heartbreaking to our entire staff that a misguided bureaucratic review like this can needlessly cause them such pain and suffering. As always, we welcome any audit or review and will participate willingly just as we have done for each of the seven previous reviews. Our desperate plea is for Medicare to allow us to continue the excellent care we have been providing for these past 26 years while this review continues."
During the last five years, the clinic has been audited by three different government agencies or contractors, and none of the reviews resulted in negative findings, the Alabama Pain Center told AL.com in September.

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