Corporate Compliance

OIG: Hospital should resolve $338,490 in questional GME reimbursements

Compliance Monitor, March 22, 2006

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The OIG has recommended that the University of Iowa Hospitals and Clinics work with CMS to resolve $338,490 related to reimbursement for residents assigned to nonhospital settings.

The OIG conducted an audit to determine whether the hospital included the appropriate number of dental residents in its full-time equivalent (FTE) counts when computing Medicare graduate medical education (GME) payments for fiscal years (FY) 2001 and 2002.

The OIG found that the hospital generally included the appropriate number of dental residents in its FTE counts used to compute FYs 2001 and 2002 GME payments. However, the number of FTE residents claimed by the hospital included educational time (i.e., classroom time for the residents when working in nonhospital settings).

In response, the hospital acknowledged that it claimed educational time but said that it believed that the time was allowable.

To perform the audit, the OIG

  • reviewed applicable regulations

  • gained an understanding of the hospital's procedures for identifying, counting, and reporting dental resident FTEs on the Medicare cost reports

  • reconciled the dental resident FTEs reported on the hospital's FYs 2001 and 2002 Medicare cost reports to supporting documentation

  • reviewed supporting documentation to determine whether the hospital appropriately included dental residents in the FTE resident counts when computing direct and indirect GME payments on Medicare cost reports

  • reviewed financial records at the hospital and the dental school to determine whether the hospital incurred all of the costs of training dental residents in nonhospital settings

  • summarized the audit results and provided them to the fiscal intermediary to recompute GME payments on the FYs 2001 and 2002 cost reports

      Click here to read the audit report, "Graduate Medical Education for Dental Residents Claimed by the University of Iowa Hospitals and Clinics for Fiscal Years 2001 and 2002," (A-04-04-06011) issued February 24, 2006.



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