The Ohio Medicaid State plan requires that:

If an audit . . . identifies amounts that . . . a hospital . . . should not have received, but did receive . . . the Department shall:

(a) Make payments to any hospital that the audit reveals paid amounts that it should not have been required to pay but did pay or did not receive amounts it should have received.

(b) Take action to recover from a hospital any amounts that the audit reveals it should have been required to pay but did not pay or that it should not have received but did receive . . . .

In accordance with the State plan, we concluded that a redistribution of the DSH overpayments is appropriate.

RECOMMENDATION

We recommend that the Ohio Department of Job & Family Services recalculate and recover the identified DSH overpayments made to the Provider of about $197,000 ($115,000 Federal share) and redistribute this amount to any hospitals that were underpaid as the result of this overpayment.

OHIO COMMENTS

In written comments to the draft report, the Ohio Department of Job & Family Services requested confirmation of its understanding that the overpayments were attributable to hospital charges for persons without insurance. It also requested details showing where charges were reported on Schedule F of the Provider’s cost report, itemized by location (inpatient or outpatient) and by eligibility type (disability assistance, uncompensated care above 100 percent of the Federal poverty level, or uncompensated care equal to or below 100 percent of the Federal poverty level). Ohio indicated that it would then work with the provider to recalculate and recover any DSH overpayments.

Ohio’s written comments are presented in their entirety as Appendix B.

OFFICE OF INSPECTOR GENERAL RESPONSE

Ohio is correct that the charges reported by the Provider resulted from services provided to patients without insurance (uninsured). We have attached, as Appendix A, a schedule of necessary adjustments to Schedule F of the Provider’s cost report, itemized by location and eligibility type.