UPMC refunds Medicare charges

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Federal officials say UPMC health system overcharged Medicare $26,547 when it incorrectly billed patients who had been to a Pittsburgh hospital, sent home and then returned the same day as new admissions on their second visit.

UPMC officials said the money has since been refunded and system changes made.

According to the report from the Office of Inspector General in the U.S. Department of Health and Human Services, UPMC Presbyterian-Shadyside in 2008 and 2009 received $913,555 for 47 readmissions in which a patient was discharged, then readmitted later that day.

In a review of 27 of the cases, inspectors found in seven cases the hospital incorrectly billed the readmission as a separate inpatient stay instead of a continuation of the earlier admission. The hospital received $112,977 for those seven cases from Medicare, when it should have received $86,430.

Medicare regulations state that if a patient is discharged then admitted the same day for symptoms related to the original admission, hospitals must bill that as a continuous stay of a single admission.

According to the inspector general, "These overpayments occurred because Presbyterian Shadyside did not have adequate training to review same-day readmission and prevent incorrect billings."

UPMC spokeswoman Wendy Zellner said Tuesday that the health system refunded the $26,547 in May. "We have strengthened our review of same-day readmissions to prevent errors in the future." Both steps were recommended in the inspector general's report.

The newly released final report states that the review was done in September 2010 and focused "on a selected risk area and does not represent an overall assessment of all claims submitted by Presbyterian Shadyside for Medicare reimbursement."

The full report can be viewed online at http://oig.hhs.gov/oas/reports/region3/31000013.pdf


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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