Review of Oxaliplatin Billing at Swedish Medical Center, Cherry Hill for Calendar Year 2005

摘要

Pursuant to Title XVIII of the Social Security Act, the Medicare program provides health insurance for people aged 65 and over and those who are disabled or have permanent kidney disease. Medicare uses an outpatient prospective payment system to pay for hospital outpatient services. Oxaliplatin is a chemotherapy drug used to treat colorectal cancer. From July 1, 2003, through December 31, 2005, Medicare required hospital outpatient departments to bill one service unit for each 5 milligrams of oxaliplatin administered. Swedish Medical Center Cherry Hill (Cherry Hill) is a hospital located in Seattle, Washington. We reviewed payments to Cherry Hill for oxaliplatin provided to Medicare beneficiaries during calendar year (CY) 2005. Our objective was to determine whether Cherry Hill billed Medicare for oxaliplatin in accordance with Medicare requirements. During CY 2005, Cherry Hill did not bill Medicare in accordance with Medicare requirements for the three oxaliplatin outpatient claims that we reviewed. Specifically, the hospital billed Medicare for an incorrect number of service units for those claims. For one of the three claims, the hospital also billed Medicare for services not provided. As a result, Cherry Hill received overpayments totaling $80,169. The overpayments occurred because the hospital did not have controls in place to ensure the proper billing of oxaliplatin.