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HRD-77-29 1 (1977-01-24)

handle is hein.gao/gaobaabwr0001 and id is 1 raw text is: DOCOENT RES0ME eJ 00503 - [A07510421 OUETRSM '2e ,4 State Audits to Identify Medicaid Overpayments tc Nursing Homes B-1640.1(3) ; HRD-77-29. January 24, 1977. Released March 4, 1977. 33 pp. + appendices (3 pp.). Report to Sen. Frank Church, Chairman, Senate Special Committee on Aging! Long-term Care Subcommittee; by Elmer B. Staats, Comptrollez Genaral. Issue Area: Health Programs: Compliance With Financing Laws and Regulations (1207); Health Programs: Reimbursement Policies and Utilization Controls (1208). Contact: Human Resources Div. Budget Function: Health: Nursing Homes (557). Organization Concerned: Department of Health, Education, and welfare. Congressional Reievance: Serate Special Committee on Aging: Long-term Care Subcommittee. Authority: 45 C.F.R. 250.30(b) (3); Social Security Act, ds amended, title XIX. r.L. 92-603, sec. 249. Techniques used by nursing home operators to intlate Medicaid costs and reimbursements were studied ir New York, 1ilorida, Massacbusetts, and Virginia. The purpose of the study was to determine the adequacy of HEW and State systems to control and deflect such costs and the progress 2ade by HEW in inplementinq State reimbursement on a cost-related basis. Findings/Conclusions: The most common type- of costs uhich should have been disallowed were: .A)npatieit care revenues, costs not related to patient care, undocumented expenses, costs of capital items expensed rather than capitalized, and capital items both expensed and capitalized. Of more than $300 million in total costs subfitted by nursing homes, States disallowed about $9 killion or three percent. Field aud'.ts were productive in identifying costs that should be disallowed, but the States varied substantially in their field audit efforts. Lab enforcement officials in New York and Massachusetts used field audits to obtain eridence for convictions of nursing home operators for fraudulent claims. The cost of State field audits will be justified if overpayments can be prevented or recouped. Recommendations: The Social and Rehabilitation Service should assess periodically whether each state identifies and reports promptly overpayments to nursing homes and should deny Federal participation in overpayments when States dc not establish an effective recoupment program promptly. (RRS)

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