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May 2, 2014

Duke University Hospital agrees to repay $626,133 for overbilling Medicare

Duke University Hospital agreed to repay $626,133 for overbilling Medicare. The announcement comes a month after the university health system agreed to refund $1 million for falsely billing federal and state health insurance programs.

Duke University Hospital has agreed to repay $626,133 for overbilling Medicare, after the U.S. Department of Health and Human Services discovered billing irregularities during an audit.

The agreement was disclosed Friday in an April 2014 report from the federal agency’s Office of Inspector General. In March, Duke concurred with all but one finding in the report and said it is improving its compliance with Medicare billing requirements.

Duke’s refund comes a month after Duke University Health System, which includes the hospital, agreed to refund $1 million in false billings to federal and state health insurance programs, including Medicare. That agreement was the result of a separate investigation, triggered by a whistle blower complaint and conducted by the N.C. Attorney General and the U.S. Attorney.

The Inspector General’s report covers a 21-month period ending Sept, 30, 2012, during which the Medicare program paid the hospital about $584 million in claims. The alleged overbillings are an extrapolation from a sample of reviewed cases and represent a markup of 0.11 percent.

The report details instances of Duke inflating costs by billing Medicare for hospital discharges that should have been coded as transfers, by coding more costly medical conditions, by billing for more costly drugs, and by failing to note that it had received credits from medical device manufacturers.

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