Some Hospitals in Medicare Jurisdiction E Claimed Residents as More Than One Full-Time Equivalent

Some hospitals in Medicare Jurisdiction E did not always claim Medicare graduate medical education (GME) reimbursement for residents in accordance with Federal requirements. Specifically, we found that 65 hospitals claimed residents for the same period as more than 1 full-time equivalent (FTE) on cost reports covering fiscal years (FYs) 2012 and 2013. As a result, 36 of the 65 hospitals received excess Medicare GME reimbursement totaling $435,000.

We recommended that Noridian Healthcare Solutions, which administers the Medicare program for MAC Jurisdiction E (1) recover $435,000 in excess Medicare GME reimbursement paid to 36 hospitals in MAC Jurisdiction E; (2) inform us of the status of the $152,000 in improperly claimed GME reimbursement self-disclosed as a result of our audit; (3) adjust the direct and indirect FTE counts claimed on the Medicare cost reports covering FYs 2012 and 2013 for each of the hospitals that did not always claim Medicare GME reimbursement in accordance with Federal requirements; (4) develop procedures to ensure that no resident is counted as more than 1 FTE in the calculation of Medicare GME payments; and (5) identify and recover any additional overpayments made to hospitals in MAC Jurisdiction E for residents whose FTE count exceeded 1 on Medicare cost reports submitted after FY 2013.