Hospital’s failure to properly code patient’s diagnosis results in $5,494 Medicaid overpayment
Docket Number: 2318254 , Decision Date: July 24, 2023
Attachment: Click here to download the decision.
A rural hospital incorrectly coded a patient’s diagnosis and treatment plan when making a Medicaid claim, which the Department of Community Health (DCH) alleged resulted in an overpayment of $5,494.83. Although the hospital argued that the treatment plans for the correct code and the submitted code were identical, the Court ultimately affirmed DCH’s recoupment of the overpayment because the agency’s policy allows recoupment in cases of “inaccurate billing.”