Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Quality Improvement Organization in New York State," (A-02-06-01023)

March 10, 2008


PDF File Complete Text of Report is available in PDF format (2.73 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The Senate Finance Committee requested that we assess the fiscal integrity of the Medicare Quality Improvement Organizations with respect to six specified fiscal integrity areas.  Of the $11.3 million of costs reviewed, $11.1 million appeared reasonable for Federal reimbursement.  Of the remaining costs, the Island Peer Review Organization, Inc. (IPRO), incurred $77,358 of costs that were unallowable and $157,218 of costs that may not have complied with Federal requirements.

We recommended that IPRO (1) refund $6,755 of unallowable duplicate meal costs, (2) reduce the indirect cost pool by $10,000 for unallowable board of directors compensation, (3) refund $60,603 of incorrectly classified direct costs and increase the indirect cost pool accordingly, and (4) work with the CMS contracting officer to determine what portion of the $157,218 conference-related costs claimed during the audit period were unreasonable and therefore unallowable and so should be refunded.  IPRO generally disagreed with the findings.