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Review of Southeast Louisiana Hospital's Hurricane-Related Uncompensated Care Claims

Louisiana did not always claim reimbursement for services provided by Southeast Louisiana Hospital (the Hospital) in accordance with Federal and State laws and regulations or with the approved provisions of the uncompensated care pool plan (the UCCP plan). In response to Hurricane Katrina, the Deficit Reduction Act of 2005 authorized Federal funding for the total costs of medically necessary uncompensated care furnished to evacuees and affected individuals without other coverage in eligible States. CMS approved Louisiana's UCCP plan to reimburse providers for medically necessary services provided to evacuees and affected individuals without other coverage.

Of the $8.3 million in costs claimed as of December 31, 2006, for services provided by the Hospital, $7.7 million was unallowable. The State claimed the unallowable costs because it (1) did not have procedures to ensure that it claimed uncompensated care costs only for services covered under the Medicaid plan, (2) did not instruct the Hospital to analyze its uncompensated care claims to determine whether payments had been received from other sources, (3) relied on the Hospital to verify that the costs claimed were based on actual inpatient days, and (4) did not have procedures to ensure that it identified all duplicate claims.

We recommended that the State refund to CMS the $7.7 million in unallowable costs claimed. Because the State's authorization to obtain Federal reimbursement for hurricane-related uncompensated care has ended, we made no procedural recommendations. In its comments on our draft report, the State disagreed with our findings and recommendation. Nothing in the State's comments caused us to revise our report.

Filed under: Centers for Medicare and Medicaid Services