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Medicare Compliance Review of Community Regional Medical Center

Community Regional Medical Center (the Hospital), located in Fresno, California, complied with Medicare billing requirements for 71 of the 301 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 230 claims, resulting in overpayments of $1.1 million. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

Filed under: Center for Medicare and Medicaid Services