Robinson Memorial Hospital in Ravenna has reached a settlement with the federal government to repay nearly $300,000 for overbilling Medicare and Medicaid for outpatient laboratory tests.
Robinson Memorial was one of 28 hospitals in the state that recently settled claims, which together totaled $5.8 million. In three waves of settlements, there have been a total of 64 hospitals that have squared away such claims, which exceed $20 million.
Steve Colecchi, Robinson Memorial's president and chief executive officer, attributed any incorrect billings to confusion concerning Medicare and Medicaid rules.
"The regulations for billing for Medicare and Medicaid for lab outpatient testing are very confusing, and in this particular case, there is example after example after example where the written directions that the hospital received from fiscal intermediaries were inconsistent," Colecchi said.
Robinson Memorial's settlement was for $269,776, which U.S. Attorney Emily M. Sweeney said might have been accumulated by overbilling patients a few dollars apiece over several years.
"The alleged amount that we overbilled for Medicare and Medicaid for 1990 through 1995 _ that's six calendar years _ was $164,490.42," Colecchi said. "Our total lab charges for that time period were more than $60 million, so the error rate was .002 percent. I would argue we have an excellent record. The only reason that any incorrect bills were submitted was because of differing regulations at the federal government."
The U. S. Attorney's office has been involved in a continuing joint initiative known as the "Ohio Hospital Project," which seeks to hold hospitals and independent laboratories responsible for the knowing submission of improper bills for outpatient laboratory tests to Medicare and Medicaid.
Most blood tests performed on blood samples are run on automated machines, which can analyze various blood factors in a single operation. Hospitals have established standard sets of blood tests that physicians routinely order for their patients. The groups of tests can be done simultaneously on the automated machines.
According to Sweeney's office, Medicare and Medicaid recognize the need to perform such common sets of tests. The programs also pay for the tests using codes that indicate how many tests result from a single operation of the machine.
The Ohio Hospital Project was created to identify facilities that separate the tests when using automated equipment by billing patients for each analysis separately or by billing for an automated test as well as for several of the analyses separately. The project also reviews selected outpatient laboratory claims for double billing and lack of medical necessity.
About 100 hospitals in the Northern District of Ohio, including Robinson Memorial, participate in a self-disclosure program, which allows the U.S. Attorney's Office to recommend all claims submitted by the participating hospitals that involve the unbundling of laboratory tests, double billing or medical necessity problems be resolved for an amount that is twice the actual overpayment.
Stipulations in the settlements include requiring hospitals to review and, if necessary, revise their billing systems to bill outpatient laboratory services to Medicare and Medicaid properly.
"To prevent any reoccurrence, we have put a number of compliance mechanisms in place to make sure we're in compliance," Colecchi said. "We're bending over backwards to make sure all of our bills are correct."
The overbilling issue has been investigated by Sweeney's office, the FBI, the U.S. Department of Health and Human Services and the state auditor's office.
Other hospitals to settle and their settlements are: Alliance Community Hospital $330,000; Bellevue Hospital $111,000; Brown Memorial Hospital in Conneaut $430,000; UHHS Bedford Medical Center, formerly known as Community Hospital of Bedford, $45,000; Community Memorial Hospital of Hicksville $63,400; Defiance Hospital $40,000; Elyria Memorial Hospital $500,000; Fairview General Hospital of Cleveland $460,000; Fostoria Community Hospital $274,038; Fulton County Health Center $80,000; Grace Hospital of Cleveland $11,000; H.B. Magruder Memorial Hospital of Port Clinton $105,487; Henry County Hospital $27,000 and Lodi Community Hospital $32,874.
Also, Lorain Community/St. Joseph Regional Health Center $196,000; MedCenter Health System, formerly known as Mansfield General Hospital $200,000; Marion General Hospital $275,000; Mercer County Joint Township Community Hospital $120,000; Parma Community General Hospital $130,034; People's Hospital of Mansfield $40,000; St. Alexis Hospital of Cleveland $70,000; St. John & Westshore Hospital of Westlake $106,110; St. Vincent Charity Hospital of Cleveland $750,000; St. Vincent Medical Center of Toledo $780,000; Samaritan Hospital of Ashland $180,207; Southwest General Hospital of Middleburg Heights $49,746, and Van Wert County Hospital $130,000.