Oklahoma Did Not Have Procedures to Identify Provider-Preventable Conditions on Some Inpatient Hospital Claims

Provider-preventable conditions (PPCs) are certain reasonably-preventable conditions caused by medical accidents or errors in a health care setting. PPCs include two categories of conditions: health-care-acquired conditions (HCACs) and Other PPCs.

Oklahoma appropriately processed and claimed Federal reimbursement for diagnosis-related group claims with HCACs. However, Oklahoma did not develop procedures to evaluate level of care (LOC) claims for HCACs. As a result, we could not determine whether it appropriately claimed Federal reimbursement for these LOC claims.

Oklahoma complied with Federal and State requirements by not claiming Federal reimbursement for Other PPCs.

We recommended that Oklahoma develop procedures to evaluate LOC claims for HCACs and determine whether payments should be reduced.

In written comments on our draft report, Oklahoma concurred with our recommendation.