CMS reduced outpatient overpayments given for patients receiving inpatient services in other facilities by updating their system, according to an audit from the HHS Office of Inspector General.
From 2016 to 2021, the audit found that Medicare inappropriately paid acute-care hospitals $39.3 million for outpatient services they provided to patients who were inpatients of other facilities.
Before May 2019, the system edits were not working correctly. After they were updated, only $3.4 million of the $39.3 million was inappropriately paid from June 2019 to December 2021.
A prior audit found that from 2013 to 2016, Medicare inappropriately paid acute-care hospitals $51.6 million for the outpatient services.
The OIG recommended that CMS direct Medicare contractors to recover as much of the $39.3 million dollars as possible within the four-year claim reopening period.