George Breen, Chair of the firm’s National Health Care and Life Sciences Practice Steering Committee, in the Washington, DC, office, was quoted in an article titled “OIG Says Cincinnati System Owes $9.8M After ‘Extrapolation’ Audit.”
Following is an excerpt:
HHS’ Office of Inspector General has told the University of Cincinnati Medical Center it must refund more than $9.8 million in Medicare payments stemming from a variety of alleged inpatient billing errors, a figure hospital officials said would have a “devastating effect” on operations.
The agency audited 228 sample claims (PDF) submitted to Medicare in 2010 and 2011 from the 695-bed teaching hospital, according to its June report. The claims mostly involved those labeled as high-risk for errors, such as medical necessity for short inpatient stays and high-severity diagnosis-related codes. OIG officials alleged 56% of the sampled claims had errors and then extrapolated from those findings to more than 2,700 claims the hospital billed during the same time period. That method of determining overall errors by taking a sample and then projecting it to an entire database is raising eyebrows.
“This is the next wave of (the OIG’s) extrapolation experiment. I think it’s the next example of the way in which the OIG is pursuing the audits and its intent to use extrapolation,” said George Breen, an attorney within the healthcare practice of Epstein Becker Green.