Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of First Coast Services Options, Inc.

The objective of this audit was to determine the extent of ineligible Medicare Skilled Nursing Facility (SNF) payments contained in our database of payments made under the administrative responsibility of First Coast Services Options, Inc. (First Coast).  Our review of the database estimated that $6.8 million of ineligible SNF payments were made under the administrative responsibility of First Coast during calendar years 1997 through 2001.  The overpayments occurred because of the absence of an automated cross-check, within the Centers for Medicare and Medicaid Services Common Working File and the Fiscal Intermediary's claims processing systems, verifying that a three consecutive day inpatient hospital stay occurred prior to SNF admission.  First Coast agreed with the findings and recommendations presented in the report and will investigate the SNF claims the OIG has determined to be unallowable and initiate recovery of the unallowable amount.