Complete Text of Report is available in PDF format (873 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.
EXECUTIVE SUMMARY:
Our objectives were to determine whether Indiana calculated the upper payment limit (UPL) in accordance with Federal regulations and the approved State plan amendment for: non-State government hospitals (including UPL payments in the calculation of hospital-specific disproportionate share hospital limits) and non-State government nursing homes. Indiana overstated the amounts available for UPL payments to non-State government hospitals by about $2.2 million for State fiscal year 2001 and by about $4.3 for 2002. The calculations were contrary to State plan provisions because they included unpaid claims rather than Medicaid payments.
We recommended that Indiana refund $3,173,161 to the Federal Government and revise its UPL methodology to exclude unpaid Medicaid claims from the calculation. In its reply, Indiana disagreed.