Medicare Graduate Medical Education Payments to New York-Presbyterian Hospital

EXECUTIVE SUMMARY:

Our objective was to determine whether New York-Presbyterian Hospital (the hospital) complied with Federal requirements in calculating the resident full-time equivalents (FTEs) used to claim Medicare direct graduate medical education (GME) and indirect graduate medical education (IME) payments for calendar year 1999.  The hospital did not fully comply with Federal requirements and therefore overstated its GME and IME FTEs on the 1999 Medicare cost report.  The hospital overstated its claim by a total of $8,411,409 for 1999, 2000 and 2001.  We recommended that the hospital (1) reimburse Medicare $8,411,409 for overclaimed GME and IME (2) make adjustments to reduce the FTE counts reported on its 1999 Medicare cost report (3) strengthen its procedures to ensure that future residents FTE counts and per resident amounts for residency specialties are calculated in accordance with Medicare requirements and (4) determine whether the errors in our review also occurred in prior and subsequent Medicare cost reports and coordinate with the Medicare fiscal intermediary to make any necessary financial adjustments.  The hospital disagreed with our findings on incorrect application of the initial residency period weight factor and excludable IME time for non-prospective-payment system units and research.  The hospital stated that it had implemented our recommendation on strengthening procedures but disagreed with our recommendation to identify errors in other periods.