Review of Quality Improvement Organization in New York State

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.