How 100 claims turned into a $12.4M OIG audit demand

OIG did not pick Methodist Hospital at random: computer matching and data mining flagged its heavy concentration of claims in known billing-error risk areas. Auditors pulled 100 inpatient and outpatient claims, found 27 that fell short of Medicare billing requirements, and extrapolated $256,926 in sample overpayments into at least $12.4 million across a $62 million frame (Butler Snow's analysis,). The hospital disputed the inpatient-rehab findings and the extrapolation itself, which cut the recommendation from about $13.5 million, while OIG put the errors mostly on staff not following existing policies.