DRG overpayments decline

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reported last week that duplicate payments associated with the diagnosis-related group payment window have fallen dramatically. From November 1990 through December 1996, the national initiative recovered roughly $73 million from 2,800 hospitals. By contrast, the OIG identified only about $5 million of potential duplicate payments for calendar years 1997 and 1998.

The OIG also reported that Medicare allowed approximately $48.5 million for medically unnecessary, undocumented, and inadequately documented physical, occupational, and speech therapy for Medicare nursing home patients during the first six months of 1999, representing an overall error rate of 24.7%. The Centers for Medicare and Medicaid Services concurred with the OIG's recommendation to improve provider education and medical review.