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Incorrect Medical Assistance Days Claimed by Hospitals

The Medicare program, like the Medicaid program, includes provisions under which Medicare-participating hospitals that serve a disproportionate share of low-income patients may receive disproportionate share hospital payments. In Medicare, disproportionate share hospital payments to providers are based on Medicaid patient days that the hospitals furnish. Providers report these Medicaid patient days on the Medicare cost reports that Medicare administrative contractors review and settle. Because Medicare disproportionate share hospital payments are the result of calculations to which a number of sometimes complex factors and variables contribute, they are at risk of overpayment. We will determine whether, with respect to Medicaid patient days, Medicare administrative contractors properly settled Medicare cost reports for Medicare disproportionate share hospital payments in accordance with Federal requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed Centers for Medicare & Medicaid Services Incorrect Medical Assistance Days Claimed by Hospitals Office of Audit Services A-07-16-04229;