Corporate Compliance

OIG finds billions in inappropriate DSH payments

Healthcare Auditing Weekly, November 11, 2008

In a review of Medicare capital disproportionate share hospital (DSH) payments, the OIG found that a number of rural hospitals and hospitals with fewer than 100 beds that claimed DSH payments between October 1, 2000 and September 30, 2006, were not eligible for such payments.
According to the report, 2,396 acute-care hospitals made DSH claims totaling $1.62 billion. Of these facilities, 397 hospitals in rural areas or with fewer than 100 beds claimed $21.9 million in unallowable capital DSH payments. The remaining $1.59 billion was claimed by hospitals that were classified as urban and had more than 100 beds, the report said.
The OIG is recommending CMS:
Direct the fiscal intermediaries (FI) to recover $21.9 million in capital DSH payments made to ineligible hospitals;
Determine whether capital DSH payments were made to inelligible hospitals for the period subsequent to the end of the OIG’s review and direct FIs to recover any unallowable payments;
Conduct reviews on a recurring basis to determine whether capital DSH payments are being made to ineligible hospitals.


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