$4M in medical education funds illegally claimed by hospitals

Hospitals are fraudulently drawing down graduate medical education funds, according to a federal audit.

HHS' Office of Inspector General discovered that some teaching hospitals claimed GME reimbursement for residents working at other hospitals or they were counting residents twice, according to a report released this week. The agency found $4 million in excess Medicare GME reimbursement. No specific hospitals were named in the report.

The audit was limited to certain areas of the country, so the improper use of GME could be more widespread, the OIG said, recommending that the CMS increase its oversight to stop abuse.

"The CMS did not have adequate procedures to ensure that hospitals do not count residents as more than one full-time employee," said the report.

For instance, the CMS did not check whether hospital data showed whether a resident was working at more than one hospital or if hospitals were counting residents as more than one full-time employee.

Medicare pays for GME funds to cover the costs of educational activities incurred by hospitals participating in the federal coverage program.

The CMS agreed with audit findings that additional oversight is needed. It is in the early stages of launching a national database for interns and residents. Previously, local Medicare contractors tracked information about residents and interns.

"Since residents often rotate to teaching hospitals in multiple jurisdictions, Medicare contractors would not have access to some hospitals' data," the CMS said in a letter to HHS' OIG.