From the public record · not a Soft Home Global client
Emergency department E/M services not in the record: what OIG found at Edward W. Sparrow Hospital
Not unless an evaluation and management service was actually provided and documented. At Edward W. Sparrow Hospital, OIG found E/M services billed on emergency visits where three patients came in for dialysis and no other condition was treated or discussed, and a fourth was billed two E/M services when the record supported one. The hospital complied on 91 of the 100 claims reviewed.
This is a summary of a published audit by the HHS Office of Inspector General. Edward W. Sparrow Hospital is not a client of Soft Home Global, and Soft Home Global had no part in the audit. Every figure is quoted from the report, which is linked below — read it rather than rely on this page. Where Edward W. Sparrow Hospital disputed a finding, that is shown too: these are audit findings, not a court’s verdict.
The audit
What went wrong, claim type by claim type
E/M services not substantiated by the record
4 of 20 outpatient claims · $853
Three patients presented to the emergency room for dialysis and no other conditions were treated or discussed, yet E/M services were billed. One patient presented for dialysis and hand pain and was billed two E/M services when the record supported one.
Why, per the report: OIG: the hospital did not have adequate controls to prevent incorrect billing within the risk areas that contained errors.
Billed as inpatient
5 of 80 inpatient claims · $46,464
Stays did not meet Medicare criteria for inpatient claims.
Why, per the report: Officials believed the claims met Medicare requirements.
How it was to be resolved
OIG recommended that Edward W. Sparrow Hospital:
- Exercise reasonable diligence to identify, report and return overpayments under the 60-day rule
- Strengthen its controls to ensure full compliance with Medicare requirements
What Edward W. Sparrow Hospital said: The Hospital disagreed with the findings, partially concurred with one of the recommendations, and said it intended to appeal.
What a practice or billing team can take from it
These points are Soft Home Global’s reading of the report, not OIG’s words.
- A visit for a scheduled procedure is not automatically an E/M visit. The note has to show a separate evaluation, and a separate problem.
- Two E/M lines need two services in the record. One complaint seen once is one service.
- A 91% clean sample still produced an estimated $550,917 overpayment once extrapolated. Small error rates are not small when the population is large.
Questions
Can a hospital bill an emergency department E/M service for a patient who came in only for dialysis?
Not unless an evaluation and management service was actually provided and documented. At Edward W. Sparrow Hospital, OIG found E/M services billed on emergency visits where three patients came in for dialysis and no other condition was treated or discussed, and a fourth was billed two E/M services when the record supported one. The hospital complied on 91 of the 100 claims reviewed.
Is Edward W. Sparrow Hospital a Soft Home Global client?
No. This page summarises a public audit report published by the HHS Office of Inspector General (report A-05-18-00045, issued 12 November 2020). Soft Home Global had no involvement with Edward W. Sparrow Hospital or with the audit.
Did Edward W. Sparrow Hospital agree with the findings?
The Hospital disagreed with the findings, partially concurred with one of the recommendations, and said it intended to appeal.
Source
Figures read from the report on 15 September 2026.
Next step
Would your claims pass the same review?
Send a ninety-day denial report and an aged AR summary, with no patient identifiers. Within two working days you get a written summary of which denial reasons are costing you most and what is recoverable.
Or write to ops@softhomeglobal.com