DOJ: 89% of hospitals guilty of double-billing
November 1, 1997 less than 1 minute read
DOJ: 89% of hospitals guilty of double-billing
Chances are good that your facility is guilty of double-billing Medicare and patients, says a new report by the U.S. Justice Department in Washington, DC. The conclusion comes from the "72-Hour Window Project," a federal investigation targeting double-billing of Medicare and patients for diagnostic tests in the 72 hours before hospitalization. The investigation began nine years ago, when the U.S. Department of Health and Human Services (HHS) audited hospitals participating in Medicare and found billing discrepancies.
Medicare rules require that any diagnostic tests in the 72 hours before a patient’s hospitalization be included in the single payment Medicare makes for the hospitalization and treatment. But the Justice Department’s investigation suggests the rule is widely ignored.
Of the 5,233 community hospitals participating in Medicare, 4,660 submitted separate bills for diagnostic tests that should have been included in the bundled payment. That’s 89% of all Medicare-participating hospitals.
The extent of the problem varies significantly from one hospital to another, according to the report. Although an overwhelming majority of hospitals were found guilty of the practice, the extent varied. Some hospitals submitted separate bills infrequently, and some made a regular practice of it.
The Justice Department got involved in 1994, when HHS determined that more aggressive action was needed to recover the $23 billion a year in improper payments. The Justice Depart-ment action has resulted in the recovery of about $45 million in overpayments, interest, and penalties from about 2,000 hospitals.
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