Review of Cleveland Clinic's Claims for Procedures That Included the Replacement of Medical Devices During 2008 and 2009

摘要

The Cleveland Clinic (the Clinic) is a 1,300-bed acute-care hospital located in Cleveland, Ohio. National Government Services (NGS) processes and pays the Clinics Medicare claims. NGS paid the Clinic a total of $11.2 million for 1,261 outpatient procedures that included the replacement of medical devices for the two-year period ending December 31, 2009, and $10 million for 407 claims for inpatient claims covering the one year period ending September 30, 2009. Our objective was to determine whether the Clinic complied with Medicare requirements for obtaining credits available from manufacturers for replaced medical devices and for reporting the appropriate billing codes and charges to reflect the credits received.