Audit of California Pacific Medical Center's Organ Acquisition Costs Claimed for the Period January 1, 1998, Through December 31, 2000

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether organ acquisition costs claimed by California Pacific on its calendar years 1998, 1999, and 2000 Medicare Part A cost reports for its kidney, liver, heart, and pancreas transplant programs were allowable.  California Pacific did not comply with Medicare law, regulations, and guidelines for claiming organ acquisition costs and received excess Medicare reimbursement for organ acquisition activities.  California Pacific claimed $710,457 in unallowable costs and $7,387,659 in unsupported costs.  The estimated Medicare overpayments for the unallowable and unsupported costs were $391,413 and $3,340,339, respectively.  The unallowable costs were associated with activities that did not comply with Medicare's definition of organ acquisition.  The unsupported costs did not comply with Medicare's documentation requirements for reimbursement.  We recognize that some portion of the unsupported costs may have related to organ acquisition activities and would have been allowable if properly documented.  We recommended that the Medicare intermediary recover the Medicare overpayment, determine the allowability of the unsupported costs, review organ acquisition costs claimed for other fiscal years, monitor future claims, and have California Pacific develop accounting controls and training programs.