tci Medicare Compliance & Reimbursement - 2005 Issue 25

Enforcement Watch: Medicaid Mistakes Put Feds In State Of Suspicion

 OIG audit deems Illinois payment monitoring inadequate.Providers beware: If your state uses an out-of-date formula to convert billed Medicaid charges to costs, the  HHS Office of Inspector General may take note. Illinois' hospital cost outlier payments increased at a faster rate than other Medicaid payments from fiscal years 1998 to 2002, according to a May 26 OIG audit that covered three Illinois hospitals.  During these years, the state's average cost outlier payment per admission increased more than 60 percent, but its average diagnosis-related group base payment per admission decreased 4.6 percent. Illinois agreed that...

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