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DOCUMENT EPSUM4E
02224 - (A1332328]
Lack of Coordination between Medicaid and Medicare at John J.
Kane Hospital. HRD-77-4; B-164031(3). May 6, 1977. 44 pp.
Report to Sen. Frank Church, Chairman, Senate Special Committee
on Aging; by Elmer B. Staat%:, Comptroller General.
Issue Area: Health Programs: CompliaLce With Financing Laws and
Regulations (1207).
Contact: Human Resources and Development Div.
Budget Function: Health: General Health Financing Assist,.nce
(555) ; Health: Nursing Homes (557g.
Organization Concerned: Depnrtment of Health, Education, and
Welfare; Health Care Financing AdministratJon; John J. Kane
Hospital, Pittsburgh, PA.
Congressional Relevance: Senate Special Committee on Aging.
Authority: Social Security Act, title XIX. Social Security Act,
title XVIII. 45 C.F. R. 250.30(a) (8). 4 5 C.F.R. 248. 3(b).
Management practices of the John J. Kane Hospital which
were reviewed included the ranagement of ratients' funds, cost
reporting for Medicaid in 1974, staffing procedures, and the
practice of crediting the Medicaid program for contributions
from relatives of patients. Finditgs/Conclusions: Medicaid and
Medicare programs at the hospital ve.-e not coordinated. Problems
caused by this lack of coordination iLcluded: patients paid for
services covered by either or both programs; the hospital
incorrectly charged the costs of some services to both programs;
State Medicaid program rules violated Federal regulations; and
audit information was not exchanged between Medicaid and
Medicare. Additional problems were identified in the hospital's
staffing practices and solicitations of contributions from
relatives of the patients. Recommendations: The Secretary of
Health, Education, and Welfare should require the Administrator
of the Health Care Financing Administration to direct the State
to: amend its state plan and regulations; make sure that Kane
Hospital patients get the required quarterly accounting of their
personal needs accounts; and insure that the hospital gets
proper authorizations of expenditures from their accounts. He
should: require the State, Kane Hospital, and other providers of
services to the hospital's patients to follow proper Medicaid
billing procedures; assure that money earned through the
investment of patients' funds is fairly distributed; direct the
State to recompute the Federal share of the Medicaid payments;
recover the Federal share of Medicaid overpayments to the
hospital; and provide for the exchange of audit information
between the Medicare intermediary and the State Auditor General.
(Author/SC)](ViewImageLocal?handle=hein.gao/gaobaacge0001&div=1&collection=&method=preview&ext=.png&size=3)