Lack of Coordination between Medicaid and Medicare at John J. Kane Hospital
HRD-77-44: Published: May 6, 1977. Publicly Released: May 6, 1977.
- Full Report:
Management practices of the John J. Kane Hospital which were reviewed included the management of patients' funds, cost reporting for Medicaid in 1974, staffing procedures, and the practice of crediting the Medicaid program for contributions from relatives of patients.
Medicaid and Medicare programs at the hospital were not coordinated. Problems caused by this lack of coordination included: 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.
Recommendation for Executive Action
Comments: Please call 202/512-6100 for additional information.
Recommendation: 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.