OIG targets 35 hospitals for stroke upcoding
In a study released last week, the Health and Human Services Office of Inspector General (OIG) determined that 35 of the nation's 4,883 prospective payment hospitals had "atypically high" billing patterns for DRG 014 — "specific cerebrovascular disorders except transient ischemic attacks."
Despite the small percentage of hospitals thought to be guilty of upcoding DRG 014 between 1993 and 1996, OIG is recommending that the Health Care Financing Administration (HCFA) considering adding it to its list of "monitored" DRGs. Medicare reimbursed hospitals almost $1.9 billion for DRG 014 in 1996. HCFA estimates that the total Medicare overpayment due to DRG 014 upcoding that year was $11.9 million.
All 35 hospitals suspected of upcoding DRG 014 have been referred to the OIG's Office of Investigations.