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Las Vegas Hospital Told to Pay $23M in Medicare Overpayments

LAS VEGAS (AP) — A hospital in Las Vegas has been asked to refund more than $23 million in services after a federal audit concluded it received millions in overpayments from Medicare.

The Office of the Inspector General for the U.S. Department of Health and Human Services conducted a routine audit of Sunrise Hospital and Medical Center of Las Vegas and claimed the hospital did not “fully comply with Medicare billing requirements” in 54 of the 100 reviewed inpatient and outpatient claims.

Five of the claims were reprocessed during the course of the audit and were removed from the amount the hospital has been asked to pay, the Las Vegas Review-Journal reported.

The audit, which selected a random sample of claims from January 2017 through December 2018, was part of a series of hospital compliance audits conducted by the federal agency. The report was released last month, and also asks the hospital to strengthen its policies to comply with Medicare requirements.

The report claims Sunrise billed Medicare for unnecessary impatient visits, or situations where the patient did not meet the standard for necessary inpatient care and “should have been billed as outpatient or outpatient with observation.”

Hospital CEO Todd Sklamberg disputed the allegations and said Thursday that it would appeal the decision.

“We strongly disagree with the OIG’s findings related to our inpatient rehab facility because we believe that the care we provided to our patients was necessary and effective,” he said.

Sklamberg also noted that the inpatient program is the only one certified by the Commission on Accreditation of Rehabilitation Facilities in southern Nevada.

HCA Healthcare, which owns Sunrise and is one of the nation’s biggest health care providers, has had issues with Medicare payments in the past. The company agreed to pay $1.7 billion between 1997 and 2003 in what the Justice Department said at the time was “the largest health care fraud case in U.S. history.”

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  • Posted on April 5, 2021