OIG begins follow-up audit of outpatient services provided to inpatients

The Office of Inspector General (OIG) will be conducting a second round of audits to determine whether acute care hospitals are being inappropriately reimbursed for outpatient services provided to inpatients, according to a recent update to the OIG’s Work Plan.

These audits are a follow up to a previous audit that found from 2013 to 2016 Medicare overpaid acute care hospitals $51.6 million for outpatient services provided to inpatients of other facilities, including critical access hospitals (CAH) and inpatient rehabilitation facilities (IRF). Under Medicare’s rules, only the facility at which the patient is an inpatient is reimbursed for covered hospital services. The inpatient facility, including CAHs and IRFs, must furnish all necessary services directly or under arrangement.

The OIG’s previous audit found that in all of the cases reviewed, the inpatient facilities were responsible for payment, and that overpayments occurred because CMS’ common working file edits were not working. The previous audit also found that acute care hospitals collected $14.3 million in unnecessary deductibles and coinsurance for these services.

The follow-up audit will determine whether CMS corrected the edits and ensure that they are working properly.