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Audit shows Sanford Health Overbilled Medicare $65,000 - Valley News Live - KVLY/KXJB - Fargo/Grand Forks

Update: Audit shows Sanford Health Overbilled Medicare $65,000

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Update....

An audit on Sanford Health forces the largest non-profit health care provider in the country to cough up 65-thousand dollars towards Medicare.

It might not seem like a lot for the hospital, which billed 222 million to Medicare the past two years. But is it just one more example of how our Medicare system is falling apart? Valley News teams Eric Crest reports.

Over the course of two years the Sanford Medical Center has filed about 150-thousand Medicare claims. Medicare in turn flipped the bill of 222 million dollars. So how much error are we talking about on the hospitals end when 65-thousand dollars is owed back to Medicare.

"That is 1/3rd of 1/10th of 1 percent error rate. Which is an extremely low rate of error compared to others that we are aware of," explains Dennis Millirons, the President of Sanford Medical Center in Fargo.

Millirons says they didn't over-bill Medicare, at least not on purpose. They say it was merely an error in billing.

"What Medicare did was reviewed 148-thousand accounts and they found 26 that they believed were in error. And we agreed and that's the result of this," says Millirons.

Sanford has 36 hospitals across the country but only one of them was audited. Even though it's just 65 thousand dollars, a drop in the bucket in the bucket for Sanford,there are people who we've talked to in the past that say the Medicare system is falling apart.

"It's just sickening to think of all this money being thrown away and somehow it's gotta be straightened out. Cause this is going downhill fast and elderly people need this," says a Grand Forks woman who would not like to be identified.

This woman was billed almost $3000 for a very similar procedure that at another clinic only cost about 300 dollars. All of which was billed to Medicare. But even though the amounts are different the hospital only receives a flat rate that's predetermined. So while her bill wasn't an error she sees the need for change in the Medicare system as a whole.

"Something has to change or Medicare will be wiped off the earth. They can't keep going like this," she says.

We spoke with the folks over at Noridian Health Care Solutions this afternoon. They deal with Medicare claims from hospitals every day. They told us it's actually more of a common occurrence that hospitals offer voluntary refunds to Medicare than to discover they actually owe.

Original Story....

SIOUX FALLS, S.D. (AP) - An audit shows that Sanford Health's flagship hospital in North Dakota owes the federal government $65,000 for over billing Medicare.

Fargo Sanford Medical Center President Dennis Millirons tells the Argus Leader (http://argusne.ws/17UjIl4) the amount is an "infinitesimal" mistake.

Inspectors with the U.S. Department of Health and Human Services reviewed 252 inpatient and outpatient claims at the Fargo hospital and found 26 billing errors for Medicare patients. Two of the cases were in 2009 and the other 24 in 2010 and 2011.

The audit says the hospital "did not have adequate controls" to prevent over billing. 

Millirons says the mistakes are a tiny fraction of business volume and need to be understood in that context. He says the Fargo hospital had 148,000 Medicare claims in 2010 and 2011 totaling $222 million.

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