Objective

The objective of our review was to confirm that Medicaid DSH payments made to the Provider during Federal fiscal year 2000 did not exceed the DSH payment limits imposed by the Omnibus Budget Reconciliation Act of 1993.

Scope

The audit was conducted in accordance with generally accepted government auditing standards and included:

• Confirmation that the Provider met the general eligibility requirements for program participation.

• Verification that Ohio appropriately calculated the hospital-specific DSH limits, and that DSH payments made to the Provider were appropriately calculated and distributed.

• Confirmation that the DSH limit calculations and DSH payments were based on accurate information, as reported on Schedule F of the Provider’s Medicaid cost reports.

Our review of management controls was limited to discussions with State officials and representatives of the Provider. These discussions were intended to facilitate our overall understanding of the DSH program, cost report preparation, and the general control procedures that have been implemented to ensure program compliance with applicable Federal and State requirements. We also completed a review of Ohio’s overall DSH program oversight, including the review of a selected State-owned institution for mental disease. The results of this review will be reported separately.

Fieldwork was completed at the Provider, located in Cleveland, Ohio and at the offices of the Ohio Department of Job & Family Services, located in Columbus, Ohio.

Methodology

At the State, we evaluated the accuracy and appropriateness of the DSH limit and payments through an analysis of various schedules prepared by Ohio, and an examination of the Provider’s cost reports, and other State accounting records.

Our review at the Provider included an evaluation of detailed account listings, a reconciliation of these listings to Schedule F of the Medicaid cost reports for the Provider’s reporting period ended September 30, 1998, and a general evaluation of the hospital’s DSH eligibility. We also selected and reviewed detailed patient records supporting the reported uncompensated care charges. These records supported the selected inpatient admission and outpatient visit transactions. We also reviewed selected transactions with large dollar amounts or the appearance of potential reporting duplications.