OIG Report: Medicare to Overpay More Than $267 Million

Medicare to Overpay More Than $267 Million for Hospital Inpatient Claims with Post-Acute-Care Transfers to Home Health Services

This important OIG report has finding of hospitals that did not properly code post-acute transfer correctly. Be sure to read the article titled, “Discharge Planning: How is a Post-Acute Transfer Defined?” to get an in-depth background of post-acute transfers.

Why OIG Did This Audit

Prior OIG audits identified Medicare overpayments to hospitals that did not comply with Medicare’s post-acute-care transfer policy (transfer policy). CMS generally concurred with the OIG’s recommendations, but subsequent analysis conducted indicated that CMS’s system edits were still not properly designed and that hospitals may be using condition codes to bypass CMS’s system edits to receive higher reimbursements for inpatients transferred to home health services.

The OIG’s objective was to determine whether Medicare properly paid acute-care hospital inpatient claims subject to the transfer policy when hospitals: