Six hospitals owe the state more than $2.5 million as the result of overcharges to the State Health Plan, according to preliminary audit results that the plan released today.
The six hospitals include Johnston Memorial Hospital, which owes $229,675, a health plan release said. Wayne Memorial Hospital in Goldsboro owes the most, at just over $1 million.
The audit may find more overcharges at other hospitals. Health plan officials say that 55 hospitals remain under review for possible overcharges, including the state's psychiatric hospitals in Raleigh, Butner, Morganton and Goldsboro. Thirty hospitals have been found to have properly charged the health plan, which serves roughly 670,000 state employees, teachers and retirees.
The plan began the review in March after learning that some hospitals were not properly notifying the plan of rate increases for out-patient medical services from as far back as 2003. The health plan, which is supported by taxpayers, has negotiated contracts with the hospitals that set rates, and required notification if they exceeded agreed upon levels.
Some hospitals have said they passed the rate change information to the plan's claims processor, Blue Cross and Blue Shield of North Carolina, assuming that the information would then be passed on to the health plan. But plan officials say the company was not required to notify the health plan.
Originally, the audit was looking at 15 hospitals, but today's news release indicates the audit has been expanded to review the roughly 90 hospitals that serve plan members.
Health plan officials said the state Attorney General's office has sent letters to the six hospitals to seek refunds of overpayments. The other four hospitals are Cape Fear Valley Medical Center, which owes $402,325; Gaston Memorial Hospital, which owes $54,659; N.C. Baptist Hospital in Winston-Salem, which owes $638,585; and Wilson Medical Center, which owes $179,784.
Plan officials say the final audit won't be completed for another several months.
