Medicare Compliance Review of Cox Medical Center for 2010 and 2011

Cox Medical Center (the Hospital) (operating in Missouri) complied with Medicare billing requirements for 177 of the 210 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 33 claims, resulting in overpayments of $302,000 for calendar years (CYs) 2010 and 2011 (31 claims) and CYs 2009 and 2012 (2 claims). Specifically, 21 inpatient claims had billing errors, resulting in overpayments of $190,000, and 12 outpatient claims had billing errors, resulting in overpayments of $112,000. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.