Medicare Compliance Review of Iowa Methodist Medical Center for 2010 and 2011

Iowa Methodist Medical Center (the Hospital) (operating in Des Moines, Iowa) complied with Medicare billing requirements for 216 of the 252 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 36 claims, resulting in overpayments of $216,000 for calendar years (CYs) 2010 and 2011 (30 claims) and CYs 2009 and 2012 (6 claims). Specifically, 25 inpatient claims had billing errors, resulting in overpayments of $131,000, and 11 outpatient claims had billing errors, resulting in overpayments of $85,000. 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.