Corporate Compliance

GOV’T AUDIT INSIDER: Medicare overpays New York hospital $8.4 million

Healthcare Auditing Weekly, May 17, 2005

Medicare overpays New York hospital $8.4 million

New York-Presbyterian Hospital overstated its direct graduate medical education (GME) and indirect graduate medical education (IME) payments for 1999, 2000, and 2001 by $8.4 million, according to an OIG audit report. The OIG recommends that the hospital reimburse Medicare for the overpayments, adjust its resident full-time equivalent counts used to calculate the costs, strengthen its procedures, and determine if the errors occurred on any other cost reports.

During the audit, the OIG did the following:

  • Reviewed applicable laws, regulations, and program guidelines

  • Interviewed hospital staff

  • Reviewed the1999 Medicare cost report

  • Reconciled the cost report data submitted to the fiscal intermediary

  • Verified defined resident participation in approved teaching programs

  • Identified residents who graduated from a foreign medical school and confirmed that the residents were certified by the Educational Committee for Foreign Medical Graduates

  • Verified the application of the appropriate initial residency period weight factor

  • Reviewed rotation schedules and other supporting documentation

  • Verified that the appropriate time was reported for residents working in areas and research unallowable for IME reimbursement

  • Verified the classifications for primary care and other specialty residency programs

  • Recalculated the final claimable counts for reimbursement

  • Determined the net dollar effect of the audit adjustments

  • Determined the dollar effect of the 1999 adjusted counts on the calendar year 2000 and 2001 cost reports

  • Discussed the results of the audit with hospital representatives

    Click here to read the audit report, "Medicare Graduate Medical Education Payments to New York-Presbyterian Hospital," (A-02-02-01011), issued April 25.

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