Review of Medicaid and Medicare Credit Balances at Aurora Sinai Medical Center, Milwaukee, Wisconsin

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether the Medicaid and Medicare credit balances recorded on Aurora Sinai Medical Center's accounting records for inpatient and outpatient services represented overpayments reportable to the Medicaid and Medicare programs.  We found that the provider did not always identify and report overpayments in a timely manner to the Medicaid and Medicare programs.  Our review disclosed that the provider's policies and procedures were not in accordance with state and federal regulations.  As a result, estimated Medicaid overpayments of $515,498 and Medicare overpayments of $637 were not reported to the programs in a timely manner.  During our fieldwork, the Medicare program recovered $193 of the overpayments.  We recommend that Aurora Sinai Medical Center:  (1) ensure Medicaid and Medicare overpayments of $515,498 and $444, respectively, are recovered by the programs; (2) revise policies and procedures to ensure that existing and future overpayments are identified and reported; and (3) submit adjustment request forms for unreported Medicaid overpayments.  Generally, Aurora Sinai concurred with the results of our review and has already initiated corrective actions with regards to the recommendations.