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Medicare Compliance & Reimbursement

Enforcement Watch:

Documentation Crusade Targets Teaching Hospitals

Published on Sun Nov 14, 2004

How decade-old alleged errors reaped a $1.9 million settlement for one PA practice.

Small lapses in the medical record at teaching hospitals could translate to big budgetary woes.
     
The Department of Health and Human Services' probe into physician billings at teaching facilities resulted in a $1.9 million civil settlement on Oct. 25 with Temple University Physicians, a physician practice of the Temple University School of Medicine.
     
According to U.S. Attorney Patrick L. Meehan, auditors reviewed 100 patient files submitted to the Medicare Part B Program for inpatient services rendered between 1995 and 1996. The feds say that numerous TUP claims were improperly up-coded, represented a greater level of service than what was actually provided and/or lacked any documentary evidence or sufficient documentary evidence.
 
TUP denies the government's allegations and denies that it has any liability in the matter.
     
Lesson Learned: The feds continue to target hospitals for documentation and coding errors made in the past.
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