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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-04-17-04058
Report Description

As part of its Research and Demonstration Waiver for Medicaid reform (the waiver), Florida established the Low Income Pool (LIP) program to compensate hospitals for providing care to low-income patients. During State fiscal years (SFYs) 2010 through 2014, hospitals received a total of $5.1 billion in LIP funds. Jackson Memorial Hospital (the Hospital) received $1.8 billion of this total.

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
7
Questioned Costs
$411,932,576
Additional Details
https://oig.hhs.gov/oas/reports/region4/41704058.asp

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267362 No $0 $0

We recommended the State agency improve its oversight of the LIP program by establishing policies and procedures for: o providing additional training to its staff members on the RFMD and STCs for the waiver; o providing training to participating hospital personnel on LIP program compliance and preparing the cost-limit calculations; and o monitoring hospital LIP calculations to verify that they comply with the RFMD and STCs including: ¿- reconciling hospital cost-limit calculations to the finalized Medicare cost reports; ¿- reviewing hospital low-income data to verify that it does not include data for undocumented aliens; ¿- reviewing hospital low-income data to verify that it does not include data for prisoners in other than an inpatient setting; ¿- testing or verifying the accuracy and completeness of the data being used by hospitals in their LIP cost-limit calculations; ¿- reviewing hospital cost-limit calculations to verify that the hospitals properly incorporate observation days and charges into the calculations, as prescribed by the RFMD; ¿- reviewing organ acquisition costs to verify that hospitals use the RFMD-required methodology and to verify the accuracy of the data used in the calculations; ¿- establishing electronic edits in the cost-limit calculation template to detect distribution errors in which low-income costs exceed total costs for individual cost centers; and ¿- reviewing section 6 costs claimed by hospitals to verify allowability based on the RFMD.

267361 No $0 $0

We recommended that the State agency revise its LIP instruction manual to instruct participant hospitals to perform the following steps when preparing the LIP cost-limit calculations: o exclude the cost of non-emergency care for undocumented aliens; o exclude the cost of caring for prisoners in other than an inpatient setting; o review section 6 costs for allowability based on the RFMD; o distribute low-income patient days and ancillary charges to cost centers consistent with the Medicare cost report; o review the calculations for clerical errors and ensure that they exclude noncompliant items; and o reduce calculated costs by all payments received including: ¿- Medicaid payments that do not relate to specific claims; ¿- the portion of Medicare cost report settlements, direct graduate medical education, bad debts, and organ acquisition cost payments that relate to Medicare dual-eligible patients.

267354 No $411,932,576 $0

We recommend that the State agency refund $411,932,576 to the Federal Government, consisting of: o $64,382,543, representing the Federal share of net Hospital self-reported LIP overpayments for the audit period and o $347,550,033, representing the Federal share of LIP cost limits calculated by the Hospital that did not comply with Federal and State requirements as identified in this audit.

Department of Health & Human Services OIG

United States