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Yale-New Haven accused of erroneous Medicare cost reports

Compliance Monitor, September 1, 2004

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In an audit report released August 19, the OIG found that Yale-New Haven Hospital failed to comply with Medicare rules in the preparation of its Medicare cost report and received excess reimbursement for organ acquisition activities.

On its fiscal year 1998 through FY 2001 Medicare cost reports, the hospital claimed more than $13.4 million for organ acquisition costs. Medicare reimburses certified transplant programs for costs associated with the acquisition of organs for transplant to Medicare beneficiaries.

Yet Yale-New Haven claimed costs associated with post-transplant activities.

Medicare allows as organ acquisition costs all costs associated with the organ donor and recipient before admission to a hospital for the transplant operation (i.e., pre-transplant services) and the hospital inpatient costs associated with the donor.

Only the portion of salaries that relates to time spent on pre-transplant activities can be included as organ acquisition costs on the Medicare cost report, according to the OIG. "If an employee performs both pre-transplant and other activities (post-transplant or non-transplant), then the related salary should be allocated to the appropriate cost centers using a reasonable basis, such as time studies," the report said.

Yale-New Haven did not have a system to identify salaries related to post-transplant activities so it claimed salary costs that were not properly supported with current, accurate documentation that differentiated between pre-transplant and post-transplant activities.

Yale-New Haven declined to comment for this story.

To read the report, click here.

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