Cedars-Sinai overbilled Medicare for bariatric surgeries, inspector general says

Cedars-Sinai Medical Center in Los Angeles submitted incorrect claims for bariatric surgery, leading to overpayments from January 2015 to December 2016, according to HHS’ Office of Inspector General

Patients with morbid obesity may receive bariatric surgery to help them lose weight by making changes to their digestive system. 

The audit, which was conducted from February 2018 through July of this year, analyzed the $1.3 million Cedars-Sinai received in Medicare payments for 62 bariatric surgery claims from 2015-16. They paired the claims with patients’ medical records to determine if they matched billing requirements for Medicare and Cedars-Sinai’s Medicare claims administrator Noridian Healthcare Solutions. 

The auditors found Cedars-Sinai didn’t comply with all of the billing requirements in 25 of the 62 claims analyzed. The inspector general and an independent medical review contractor found information in patients’ medical records didn’t support eligibility requirements for bariatric surgery.

Cedars-Sinani should repay Medicare $154,074 in overpayments and update its billing procedures to correct the problem, the auditors said. The medical center agreed with most of the auditors’ recommendations.

Read the full report here.

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