Duke to repay Medicare overpayments

May. 02, 2014 @ 06:01 PM

Duke University Hospital will repay $626,133 for Medicare overpayments determined by an audit of claims that were made between Jan. 1, 2011, and Sept. 30, 2012.

While the hospital will pay the full amount, Duke Medicine released a statement Friday saying that the hospital plans to appeal one claim.
The hospital is disputing one of 72 claims that an audit by the Department of Health and Human Services Office of Inspector General found were not in compliance with Medicare billing requirements in the period.
The office reviewed a sample – or 251 claims –out of 2,905 Medicare claims by the hospital that were considered to be at-risk for billing errors.
The 72 claims resulted in a net overpayment of $262,884, according to the audit, and from that sample, the office estimated that the hospital received overpayments of $626,133 in the period.
In addition, according to the report, the hospital also has taken steps to strengthen controls to make sure it fully complies with Medicare requirements.
Duke University Health System has already agreed to pay $1 million to resolve allegations that it made false payment claims to federal health care programs, according to previous reports in The Herald-Sun.
Resolution of the case didn’t determine liability, but instead leaves the claims classified as allegations.
The allegations were raised by a whistleblower lawsuit filed by former employee Leslie Johnson. She worked for Duke's Patient Revenue Management Organization, which provided billing, collection and administrative services to the health system.
In her suit, Johnson accused the nonprofit corporation that operates Duke University Hospital, Duke Regional Hospital and Duke Raleigh Hospital of making false claims to Medicare, Medicaid and TRICARE.