Review of Gwinnett Medical Center's Claim for Medicare Disproportionate Share Hospital Payments for Fiscal Year 1999

EXECUTIVE SUMMARY:

This report points out the results of our review of the revised Medicare disproportionate share hospital (DSH) claim submitted by Promina Gwinnett Medical Center (PGMC) for fiscal year ended June 30,1999.  We found that PGMC's claim for Medicare DSH reimbursement of $2,386,024 was overstated by $288,564.  This overstatement occurred because the Medicaid eligible days used in PGMC's revised DSH calculation were overstated.  Medicaid eligible days were overstated due to the incorrect inclusion of days related to dual eligible beneficiaries and duplicated days for some beneficiaries.  We recommended that the hospital revise its claim to reflect the audited Medicaid eligible days count, thus reducing the revised DSH adjustment and amount requested by $288,564.  We also recommended that PGMC establish procedures to assure only allowable days are included in its future DSH adjustment calculations.  The hospital generally agreed with our findings and recommendations.