◆ CMS on Dec. 19 posted detailed information on 2019 Medicare fee-for-service improper payments. One of many findings: 59.5% were caused by insufficient documentation.^[1]

◆ In one of its largest extrapolations in a provider compliance audit, the HHS Office of Inspector General (OIG) estimated that Texas Health Presbyterian Hospital Dallas received $10.7 million of overpayments based on net overpayments of $500,323.^[2] OIG audited a stratified random sample of 100 claims paid in 2016 and 2017 and said 41 were not fully compliant: 27 inpatient rehabilitation facility (IRF) claims didn’t meet coverage or documentation requirements; eight inpatient admissions should have been billed as outpatient or observation; and six DRG and HCPCS codes were incorrect. In a written response, Liz Madzik, chief compliance officer of Texas Health Resources, said it “generally disagrees with many of the findings.” For example, its internal review of IRF claims found that 25 have adequate documentation to meet Medicare criteria. She noted that “Texas Health Resources maintains a robust, highly reliable compliance program.” OIG’s recommendation that the hospital refund $10.7 million to Medicare “at this point would deny Texas Health Resources its right to appeal any of the extrapolated claims, which is fundamentally unfair,” Madzik wrote.