Review of Outpatient Psychiatric Services Provided by Saint Luke's-Roosevelt Hospital for Calendar Year Ended December 31, 1997

EXECUTIVE SUMMARY:

This final audit report estimates, based on a statistical sample, that at least $1,129,740 in outpatient psychiatric services claimed by the Saint Luke's-Roosevelt Hospital did not meet Medicare reimbursement criteria. Specifically, charges for outpatient psychiatric services lacked sufficient patient treatment plans, sufficient medical record documentation, and/or were not reasonable and necessary. We also noted unallowable charges for noncovered items totaling $46,019 on the Hospital's Calendar Year 1997 cost report. In addition to financial adjustments, we recommended that the Hospital strengthen its procedures to ensure that charges for outpatient psychiatric services are reasonable and necessary and are properly documented in accordance with Medicare regulations and guidelines. We also recommended that the Hospital develop procedures to report noncovered services as nonreimbursable cost centers on its Medicare cost reports.