Corporate Compliance

Portion of Southern California Renal Disease Council Medicare claims not allowed

Compliance Monitor, May 30, 2012

The Southern California Renal Disease Council is facing a hefty potential bill for costs not allowed by its Medicare contract. Only $2.6 million of $5.45 million of costs reviewed during an OIG audit are allowed by the council’s contract with Medicare.

The OIG determined that approximately $113,000 was not allowable, and it set the remaining $2.7 million aside for Medicare resolution because the council did not maintain supporting documentation for review. The OIG deemed the costs unallowable because the council did not have adequate controls to account for costs claimed under federal contracts.
 
The OIG recommended that the council do the following:
  • Refund $112,670 for unallowable costs
  • Work with CMS to determine the allowability of the $2,740,384 that the OIG set aside
  • Refund any amount determined to be unallowable
  • Strengthen its controls to account for costs claimed under federal contracts

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