Graduate Medical Education for Dental Residents Claimed by the Medical College of Virginia Hospital for Fiscal Years 2000 Through 2002

EXECUTIVE SUMMARY:

Our objective was to determine whether the Medical College of Virginia (the Hospital) included the appropriate number of dental residents in its full-time equivalent (FTE) counts when computing Medicare graduate medical education (GME) payments for fiscal years (FYs) 2000 through 2002.  Although the Hospital appropriately included dental residents in its FTE counts used to compute FYs 2001 and 2002 GME payments, in FY 2000 the Hospital inappropriately included 41.90 direct GME FTEs and 34.07 indirect GME FTEs in the counts without incurring all of the costs of training dental residents in nonhospital sites that year.  Because the FY 2000 FTEs were used in the 3-year rolling average, the Hospital overstated its direct and indirect GME claims by a total of $1.6 million for FYs 2000 through 2002.  The Hospital also included didactic, i.e., classroom, time for the residents when working in nonhospital settings.

We recommended that the Hospital:  (1) file an amended cost report to refund $1,644,284, (2) establish and follow procedures to ensure that the FTE counts for residents in nonhospital settings include only those FTEs for which the Hospital has incurred all or substantially all of the training costs, (3) determine whether similar errors occurred after FY 2002 and refund any overpayments, and (4) work with CMS to resolve the $473,116 related to FYs 2001 and 2002 FTEs for the didactic time of residents assigned to nonhospital settings.  The Hospital generally disagreed with our findings and recommendations.