Medicare Compliance Review of Saint Mary's Health Center for 2011 and 2012

Saint Mary's Health Center (the Hospital) (operating in Saint Louis, Missouri) complied with Medicare billing requirements for 181 of the 193 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 12 claims, resulting in overpayments of $69,000 for calendar years (CYs) 2011 and 2012 (10 claims) and CY 2010 (2 claims). Specifically, eight inpatient claims had billing errors, resulting in overpayments of $40,000, and four outpatient claims had billing errors, resulting in overpayments of $29,000. 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.