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EXECUTIVE SUMMARY:
The objective of our review was to determine whether outpatient pharmacy services at Cape Cod Hospital (the Hospital) were billed for and reimbursed in accordance with Medicare regulations. Based on the statistical sample, we estimated that CCH had overstated its FY 1998 Medicare outpatient pharmacy charges by at least $188,989. The essence of the overpayments involved charges for Epoetin (EPO) treatments that were determined in the medical claims review by the Fiscal Intermediary (FI) to have been incorrectly reimbursed. Furthermore, we determined that the Hospital billed Medicare for medications not properly supported by medical records, for self-administered drugs not reimbursable by Medicare, and for clerical errors. We noted that the Hospital did not have or follow existing procedures for the proper billing of outpatient pharmacy services.