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Office of Inspector General (OIG) Audits of Kaiser Foundation Health Plan



09-24-2008 - Audit (A-09-07-00083)
Review of Kaiser Foundation Hospital-Vallejo's Reported Fiscal Year 2005 Wage Data
Executive Summary
Kaiser Foundation Hospital-Vallejo (the Hospital) overstated its wage data by $11.8 million and 252,882 hours in its fiscal year (FY) 2005 Medicare cost report. Correcting the Hospital's errors increased the average hourly wage rate from $49.75 to $50.17. Under the acute-care hospital inpatient prospective payment system, the Centers for Medicare & Medicaid Services (CMS) adjusts the Medicare base rate paid to participating hospitals by the wage index applicable to the area in which the hospitals are located. CMS updates the wage indexes annually based on hospitals' reported wage data.

We recommended that the Hospital submit a revised FY 2005 Medicare cost report to the fiscal intermediary to correct the wage data overstatements and strengthen review and reconciliation procedures to ensure that the wage data reported in future Medicare cost reports are accurate, supportable, and in compliance with Medicare requirements. In its written comments on our draft report, the Hospital provided information on actions taken to implement our recommendations.

Complete file mirrored here at:  
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September 17, 2008 -  
Review of Kaiser Foundation Hospital - Vallejo's Reported Fiscal ... ... Kaiser
California. ... KAISER FOUNDATION HOSPITAL–VALLEJO COMMENTS ... Foundation Hospital–Vallejo (the Hospital) is a 287-bed hospital in Vallejo,
Complete file mirrored here at:  


May 28, 2008 -  STATUS OF THE INSURANCE AUDITS
HIGHLIGHTED IN THE OFFICE OF THE INSPECTOR GENERAL'S REPORT

REPORT, REPORT NUMBER, AND DATE                                                                                  STATUS                                

Kaiser Foundation Health Plan, Inc.                            All outstanding audit issues have been resolved and the FEHB
Northern and Southern California Regions                 Program has been reimbursed for $1,988,953 and $1,874,425
Pasadena, California                                                    respectively.
1C-59-00-07-018
1C-62-00-07-019
May 28, 2008
Federal Employees Health Benefits Program
Source:
File mirrored here:  http://fines.kaiserpapers.org/oig-audits/pdfs/
SAR39-ManagementResponse.pdf


June 4, 2003 - At the request of the California Office of Emergency Services (OES), the Office of Inspector General (OIG) performed an interim audit of public assistance funds awarded to the Kaiser Foundation Health Plan, Inc., Los Angeles, California (Health Plan). The objective of the audit was to determine whether the Health Plan expended and accounted for Federal Emergency Management Agency (FEMA) funds for completed projects according to federal regulations and FEMA guidelines.

The OIG conducted this audit concurrently with an audit of the Kaiser Foundation Hospital (Hospital), Public Assistance Identification Number 037-90328 (OIG Audit Report Number D0-09-03, dated May 29, 2003). Since the Health Plan and Hospital commingled their funding and accounting practices, the OIG’s audit of the 40 large Hospital projects provided the fieldwork testing for the Health Plan. The OIG reviewed
the Health Plan’s funding for all small projects to identify applicable insurance recoveries (see Exhibit).


............  "Therefore, the OIG is recommending that FEMA Region IX, alert OES as the grantee, of the Health Plan’s material internal control weaknesses."
Complete file mirrored here at:  

12-05-2005
Kaiser Foundation Hospital, California, agreed to pay $20,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that the hospital failed to provide an appropriate medical screening examination to a 53-year-old man who presented to its emergency department after being in a motorcycle accident. The patient returned to the ED the following day, was admitted and treated.
Source:
11-12-2004
Kaiser Foundation Hospital (KFH), California, agreed to pay $10,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that KFH failed to provide an appropriate medical screening examination to a pregnant woman who presented to KFH’s emergency department (ED) with complaints of abdominal and back pains. The patient was allegedly instructed by a labor and delivery nurse to go to the hospital where her physician had privileges. The patient left the hospital without being evaluated.
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May 29, 2003 -  At the request of the California Office of Emergency Services (OES), the Office of Inspector General (OIG) performed an interim audit of public assistance funds awarded to the Kaiser Foundation Hospital, Los Angeles, California (Hospital). The objective of the audit was to determine whether the Hospital expended and accounted for Federal Emergency Management Agency (FEMA) funds for completed projects according to federal regulations and FEMA guidelines.

The OIG also recommends that the Regional Director, FEMA Region IX, alert OES as the grantee, of the Hospital’s continuing material internal control weaknesses and inform the Hospital that it must maintain a system of internal control that provide reasonable assurance that federal grant awards are managed in accordance with laws and regulations.
Complete file mirrored here at:  

April 15, 2003
Kaiser Foundation Hospital – Sunset, Los Angeles, California, agreed to pay $20,000 to resolve its liability for CMPs under the patient dumping statute. The OIG alleged that Kaiser was a hospital that had specialized capabilities or facilities that refused to accept the transfer from another hospital of an 83-year-old patient needing Kaiser’s capabilities for coronary bypass surgery. The OIG alleged that Kaiser’s cardiac surgeon refused to accept the transfer saying that the patient was too unstable to transfer and that he was going to die anyway. The patient was transferred to another hospital where he underwent successful surgery and was discharged.
Source:

December 23, 2002 - EXECUTIVE SUMMARY:
The objective of this review was to assess whether Kaiser properly valued and reported the prescription drug additional benefit in the Calendar Year 2000 Adjusted Community Rate Proposal.  Our review found that Kaiser paid less than the average manufacturer price for the prescription drugs we reviewed and, therefore, properly valued those drugs.  Additionally, we found the prescription drug additional benefit reported in the Calendar Year 2000 Adjusted Community Rate Proposal was properly based on actual costs.

Complete file mirrored here at:  
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May 19, 2000 -
"Review of Medicare Payments for Beneficiaries with Institutional Status - Kaiser Foundation Health Plan, Cleveland, Ohio," (A-05-99-00045)

EXECUTIVE SUMMARY from OIG:

The objective of this review was to determine if capitation payments to Kaiser Foundation Health Plan were appropriate for beneficiaries reported as institutionalized.  We determined that Kaiser received Medicare overpayments totaling $11,214 for 15 beneficiaries incorrectly classified as institutionalized.  The 15 beneficiaries were part of a statistical sample of 100 Medicare beneficiaries reported as institutionalized during the period January 1, 1996 through December 31, 1998.  Based on our sample results, we estimate that Kaiser received Medicare overpayments of at least $49,963 for beneficiaries incorrectly classified as institutionalized.  The majority of the overpayments occurred because, prior to 1997, Kaiser staff did not consistently verify the institutional residency of beneficiaries.

Complete file mirrored here at:

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Office of Inspector General -- AUDIT

"Review of Medicare Payments for Beneficiaries with Institutional Status, Kaiser Foundation Health Plan, Portland, Oregon," (A-05-97-00023)
April 27, 1998

EXECUTIVE SUMMARY:


This final report provides the results of our audit entitled, "Review of Medicare Payments for Beneficiaries with Institutional Status." Our objective was to determine if payments to Kaiser Foundation Health Plan, under Medicare risk contract H9003, were appropriate for beneficiaries reported as institutionalized.
 

We determined Kaiser received Medicare overpayments totaling $10,472 for 20 benenficiaries incorrectly classified as institutionalized. The 20 beneficiaries were part of a statistical sample of 100 Medicare beneficiaries reported as institutionalized during the period October 1, 1994 through September 30, 1996. Based on our sample results, we estimate that Kaiser received Medicare overpayments of at least $105,624 for beneficiaries incorrectly classified as institutionalized during the audit period.
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