From the public record · not a Soft Home Global client
Operating room units and rehabilitation stays: what OIG found at St. Francis Hospital, Peoria
As the number of times the service was actually performed. At St. Francis Hospital in Peoria, OIG found 3 of 5 sampled outpatient claims billed operating room services with more than one unit incorrectly; hospital officials attributed it to human error in interpreting revenue and usage reports. Eight inpatient rehabilitation stays that did not meet Medicare criteria accounted for most of the $204,265 in sampled overpayments.
This is a summary of a published audit by the HHS Office of Inspector General. St. Francis 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 St. Francis 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
Operating room services billed with more than one unit
3 of 5 outpatient claims · $741
Service units did not equal the number of times the procedure was performed.
Why, per the report: Hospital officials stated the errors were "human error related to inconsistent application or interpretation of information from available revenue and usage reports."
Inpatient rehabilitation that did not meet Medicare criteria
8 of 95 inpatient claims · $195,827
Stays did not meet Medicare criteria for acute inpatient rehabilitation.
Why, per the report: Officials contended the claims met Medicare requirements.
Inpatient status and discharge coding
3 of 95 inpatient claims · $7,697
Two stays should have been billed as outpatient or outpatient with observation; one claim was underpaid because its discharge status code was wrong.
Why, per the report: Officials contended the inpatient claims met Medicare requirements.
How it was to be resolved
OIG recommended that St. Francis Hospital:
- Refund the estimated overpayments within the 4-year reopening period
- Exercise reasonable diligence to identify, report and return overpayments under the 60-day rule
- Strengthen controls to ensure full compliance with Medicare requirements
What St. Francis Hospital said: The Hospital disagreed with most findings and recommendations, agreed with 6 of the 14 sampled errors, and challenged OIG's authority to use statistical sampling and extrapolation.
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.
- Units are a count of what was done, not a count of what a report or a charge line suggests. Where a system reports usage, someone still has to reconcile it to the note.
- A wrong discharge status code costs money in both directions — this one underpaid the hospital.
- OIG attributed the errors to controls that were not adequate for the risk areas that contained errors. The fix is targeted review, not more review.
Questions
How should service units be billed on an outpatient surgery claim?
As the number of times the service was actually performed. At St. Francis Hospital in Peoria, OIG found 3 of 5 sampled outpatient claims billed operating room services with more than one unit incorrectly; hospital officials attributed it to human error in interpreting revenue and usage reports. Eight inpatient rehabilitation stays that did not meet Medicare criteria accounted for most of the $204,265 in sampled overpayments.
Is St. Francis Hospital a Soft Home Global client?
No. This page summarises a public audit report published by the HHS Office of Inspector General (report A-05-18-00048, issued October 2020). Soft Home Global had no involvement with St. Francis Hospital or with the audit.
Did St. Francis Hospital agree with the findings?
The Hospital disagreed with most findings and recommendations, agreed with 6 of the 14 sampled errors, and challenged OIG's authority to use statistical sampling and extrapolation.
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