Medicare Compliance Review of JFK Medical Center for Calendar Years 2009 and 2010.

摘要

JFK Medical Center (the Hospital) is a 460-bed acute care facility located in Atlantis, Florida. According to CMSs National Claims History data, Medicare paid the Hospital approximately $208 million for 30,572 inpatient and 40,770 outpatient claims for services provided to beneficiaries during calendar years (CY) 2009 and 2010. Our audit covered $25,195,979 in Medicare payments to the Hospital for 3,816 claims that were potentially at risk for billing errors. We randomly selected a sample of 200 (196 inpatient and 4 outpatient) claims with payments totaling $1,320,562 for review. These 200 claims had dates of service in CYs 2009 and 2010. Our objective was to determine whether the Hospital complied with Medicare requirements for billing inpatient and outpatient services on selected types of claims.