Review of Graduate Medical Education And Indirect Medical Education At Saint Elizabeth's Medical Center For Fiscal Year Ending September 30, 1999

EXECUTIVE SUMMARY:

The objective of this review was to determine the accuracy of resident Full-Time Equivalents (FTE) counts used by the Saint Elizabeth's Medical Center (SEMC) during Fiscal Year (FY) 1999 to calculate Graduate Medical Education (GME) and Indirect Medical education (IME) payments.  We determined that SEMC overstated its calculations for IME and GME by 2.84 and .47 FTEs, respectively.  These overstatements occurred because SEMC claimed reimbursement for residents: 1) who spent time in unallowable research activities; 2) who exceeded their initial residency period yet were counted as if they were within their initial residency period; 3) whose time was not supported with adequate documentation; 4) who rotated to non-hospital settings; and 5) who were misclassified as primary care residents.  We also identified a cost reporting error involving the Per Resident Amounts update factor.  As a result of these errors, the hospital overclaimed GME and IME reimbursement by $121,395 on its FY 1999 Medicare cost report. 

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