Medicare Compliance Review of Jackson-Madison County General Hospital for Claims Paid From June 1, 2013, Through May 31, 2015

Jackson-Madison County General Hospital (the Hospital), located in Jackson, Tennessee, complied with Medicare billing requirements for 141 of the 200 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 59 claims, resulting in net overpayments of approximately $189,000 for the audit period. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $1.4 million for the audit period. 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.