Out of the 244 inpatient claims reviewed by the investigators, it was found that 58 inpatient claims overbilled Medicare by $451,412.
The investigators reviewed seven outpatient claims and found that one claim overbilled Medicare, which UNC said was the result of a lack of coordination between people in separate departments. This claim over-billed by $583.
For 37 of the inpatient claims, the report said UNC Hospitals billed for beneficiary stays that should have been billed as outpatient claims. For 19 of the inpatient claims, the Hospitals submitted incorrect codes, according to the report.
Dardess said UNC Hospitals acknowledges that human error resulted in some of the claims but refutes the idea that the hospital system doesn’t have an adequate system for preventing billing errors.
“UNC Hospitals takes compliance with program requirements seriously and has devoted extensive resources and adopted comprehensive measures to support its billing programs,” she said.
Richard Saver, who is a professor in the UNC School of Law, said hospitals encounter billing problems with Medicare due to the complexity of the program and submission of codes.
“Sometimes there is disagreement as to how to code a particular round of care,” he said. “Sometimes the guidance from the government as to how to code is unclear.”
Joan Krause, a professor in the UNC School of Law, said completing an internal investigation to determine if the government is wrong is important when responding to audits as a lawyer.
“Strategically, you have to find if it is worth arguing about,” she said.