Update: OIG says Mount Sinai owes them $42 million, but hospital says it's 'too late'

New York hospital owes millions for improperly billed Medicare claims in 2012 and 2013, but the recovery period may have passed.
By Bernie Monegain
11:22 AM
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Mount Sinai owes OIG $42 million

New York-based Mount Sinai Hospital owes the government nearly $42 million for improperly billed Medicare claims in 2012 and 2013, according to the Department of Health and Human Services’ Office of the Inspector General, and the agency wants that money back.

Mount Sinai, however, has told OIG is that it’s too late for recovery.

According to the OIG report, Mount Sinai disputed the OIG findings in writing, asserting the Medicare portion, which makes up the majority of
overpayments OIG identified, could no longer be recovered by CMS because the agency was past the deadline for recovery.

Mount Sinai added that some of the claims at issue fell outside of a 4-year reopening period and do not need to be returned. 

"We reject the notion that it’s appropriate for OIG auditors to substitute their judgments, made years after the fact without any patient interaction,” Mt. Sinai said in a statement.

Mt. Sinai added that 97 percent of the refund demand relates to claims OIG never even reviewed.

The hospital did not dispute OIG’s determination that the hospital incorrectly billed four inpatient claims and 21 outpatient claims, which amounted to $219,523. Mount Sinai executives said they would submit refunds for some of these claims provided they fell within the claims period.

OIG, on the other hand, is standing by its findings.

“We maintain that our findings are valid and continue to recommend that the hospital return any identified overpayments. Providers who identify overpayments are required to return them within 60 days. In addition, providers must exercise reasonable diligence to determine whether overpayments of a similar type existed during a six-year lookback period.”

OIG also recommended Mount Sinai strengthen its controls to ensure full compliance with Medicare requirements going forward.

The OIG review is part of a series of hospital compliance reviews. Using computer matching, data mining, and data analysis techniques, OIG identified hospital claims that were at risk for noncompliance with Medicare billing requirements.

Mount Sinai said that it intends to vigorously defend itself in court, and noted the healthcare provider has prevailed on appeal in more than 85 percent of similar cases.

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com


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