Medicare Compliance & Reimbursement

'The consultant told me to' is no defense. If you've increased your charges to potentially increase outlier reimbursement, you'd better have the documentation to stand behind your charges, because the DOJ is waiting to pounce. A Texas hospital recently agreed to pay $9.99 million to settle allegations that it improperly inflated charges for inpatient and outpatient care to obtain outlier payments from Medicare, according to a March 26 Dept. of Justice (DOJ) press release. This settlement is just the latest in a string of allegations that the DOJ has made regarding outlier payments. Last month, a New Jersey-based consulting firm paid nearly $3 million to resolve allegations that it advised its hospital clients to increase charges to raise outlier payments. There is nothing wrong with charging for higher outlier cases in accordance with the supplemental outlier payment system which Congress enacted to incentivize hospitals to provide care for patients with [...]