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HHS OIG: Medicare Could Save Millions by Strengthening Billing Requirements for Canceled Elective Surgeries

August 1, 2013

Pursuit's Take

On the basis of our sample results, we estimated that Medicare made $38.2 million in Part A inpatient hospital payments in calendar years 2009 and 2010 for short-stay, canceled elective surgery admissions that were not reasonable and necessary. For 80 of the 100 claims in our sample, Medicare made payments totaling $346,000 for hospital inpatient claims involving canceled elective surgeries when a clinical condition did not exist on admission or a new condition did not emerge after admission that required inpatient care.

Media Coverage

Fierce HealthCare: Revised billing rules for canceled surgeries could save millions

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