Medicare Compliance & Reimbursement

The OIG can involve Medicare FIs identity duplicate claims.

Providers should make sure they follow the Medicare Provider Reimbursement Manual's requirements for their Medicaid cost reports, if their state regulations don't modify it.

Las Cruces, NM for-profit nursing facility Casa De Oro claimed more than $103,000 in costs that were unallowable under state regulations and Medicare requirements, the HHS Office of Inspector General said in an audit released on July 21. The audit focused on Casa's fiscal year 2000 Medicaid cost report, which the state used to calculate reimbursement rates for Casa's claims from July 1, 2001 to June 30, 2004.

Integrated Health Services owned Casa and 22 other nursing facilities in New Mexico at the time of the audit, but sold them to Abe Briarwood Corp. in 2003. Most of the unallowable costs were IHS management fees, including unallowable reorganization costs, unsupported costs and duplicate costs reported to both Medicaid and CareFirst of Maryland, Inc., IHS' Medicare fiscal intermediary.

The OIG attributed the other unallowable costs to unsupported costs and charges that the company didn't reduce to cost or comparable services' prices. Briarwood should resubmit an adjusted cost report to the state and the state should collect the overpayments, the OIG recommends.

A Briarwood representative told the OIG that the company didn't disagree with the findings.

To read the audit, go to http://www.oig.hhs.gov/oas/reports/region6/60300082.pdf.