At the end of last year, the HHS Office of the Inspector General (OIG) released a report listing its top recommendations to the Centers for Medicare and Medicaid Services (CMS) that CMS has not implemented. Among those is a recommendation to address hospital overbilling, reports Amanda Norris for HealthLeaders. Hospital overbilling, both to Medicare and to commercial insurers, drives up costs for everyone.
The OIG reports overpayments of $1 billion from hospitals charging inappropriately for a diagnosis of severe malnutrition in fiscal years 2016 and 2017. We don’t know all the other inappropriate diagnosis codes different hospitals are assigning to patients in their care that are driving up Medicare spending and costs to people with Medicare. What we do know is that inappropriate and excessive charges can mean higher coinsurance for patients and higher Medicare costs for taxpayers.
The OIG has found that, overall, hospitals are claiming that their patients in their care are “at the highest severity level,” which increases their payments from CMS. The proportion of patients claimed to be “at the highest severity level” has gone up significantly over the last several years. How many of them are at the highest severity level, in fact, is unclear.
OIG made a series of recommendations to address the issue of overpayments to hospitals resulting from inappropriate diagnoses, which CMS has yet to implement. Among those recommendations is that CMS review Medicare Severity Diagnosis Related Groups and other diagnoses that are easily upcoded as well as the hospitals that have disproportionate levels of these codes. CMS did not agree to undertake this effort.
The OIG explains that these reviews are necessary to Medicare’s fiscal integrity. They are also necessary to control out-of-pocket costs for people with Medicare, including higher costs for Medicare supplemental coverage.
Here’s more from Just Care:
- How to ensure your hospital bill is correct
- Plan ahead for a hospital visit: Talk to the people you love about these seven important items
- Hospitals find a lot wrong with Medicare Advantage
- Hospitals still not disclosing their prices, violating the law
- For-profit hospitals are causing rising medical debt and personal bankruptcy
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