Hospitals may be improperly billing Medicaid for inpatient services that should have been billed as outpatient care, a new audit by the office of New York state Comptroller Thomas P. DiNapoli suggests. The audit, which was shared exclusively with POLITICO, identified nearly $361 million worth of fee-for-service inpatient claims for Medicaid enrollees discharged within 24 hours of Hospital admission — suggesting a portion of those 34,000-plus claims were improperly billed as pricier inpatient claims instead of outpatient services, which are generally less expensive. Inpatient care generally involves patients who, on the recommendation of a physician or licensed practitioner, stay at least overnight in a hospital and receive room, board and continuous nursing service. Among a judgmental sample of 190 of those claims, representing six hospitals, auditors found 48 percent had been billed improperly. “The state Department of Health needs to give clearer guidance so hospitals know whether to bill for services as outpatient, rather than more expensive inpatient care,†DiNapoli said in a statement. “Nearly half the bills we looked at got it wrong and that kind of error rate results in millions of dollars in Medicaid overpayments.†In response to the audit, the Health Department said it will review its inpatient manual to see whether it clearly explains the criteria to submit an inpatient claim and make updates where appropriate. The department said it would also explore processes to identify and review inpatient hospital claims for short stays, as recommended by the comptroller’s office. IN OTHER NEWS: — Catholic Health and New York-Presbyterian have signed a clinical collaboration agreement to expand access to cardiac care on Long Island, the health care systems announced. The collaboration will expand St. Francis Hospital & Heart Center’s advanced heart failure, adult congenital heart disease and pediatric cardiology programs and also extend New York-Presbyterian’s heart transplant program to Long Island. ON THE AGENDA: — Today at 1 p.m. The Emergency Medical Services for Children Advisory Council meets. — Thursday at 10:15 a.m. The Public Health and Health Planning Council's Codes, Regulation and Legislation Committee will convene, followed by a meeting of the full council. GOT TIPS? Send story ideas and feedback to Maya Kaufman at [email protected]. Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories.
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