Mistake results in hospitals having to pay back

By Christina Calloway

PNT senior writer


A calculation blunder by the state has resulted in Roosevelt General Hospital and other hospitals statewide having to pay back money to the Sole Community Provider Fund, which distributes money to hospitals quarterly for Medicare and Medicaid services.

According to RGH’s Chief Financial Officer Eva Stevens, the hospital was overpaid $536,343 in October of 2012 and is now expected to repay that amount. But she says the hospital is expected to receive $2.7 million for the 2013 fiscal year now that the error has been corrected.

“We’ve gotten (Sole Community Provider) payments for years. They found out what they miscalculated from CMS (Centers for Medicare and Medicaid services) and it took them months to figure out how would it be redistributed.”

Stevens said payments stopped to the hospital in October, but payments are expected to resume next week.

“Things move slowly at that (federal) level,” said RGH CEO Larry Leaming.

But Leaming says he’s relieved the issue has been fixed because the money goes to care that’s delivered to people who have no source of payment. Hospitals that qualify to receive money from the fund have to be the sole hospital in a community.

“It’s tough for people,” said Matt Kennicott, director of external affairs for New Mexico Human Services Department. “The error was discovered through normal business and was reported to CMS. They said, ‘OK, we need to fix this.’”

Kennicott said he felt the state came out on top because they were able to avoid a multi-million dollar problem. And, though the error affected previous years, Kennicott said hospitals were only expected to pay back money from the last fiscal year.

“We’re going to end up with a little over $2.7 million in funds to help pay for indigent care,” Leaming said. “I’d trade $500,000 for that any day. There’s not a big problem, if you take a look at the big picture, it’s a net benefit for us. We’re getting a lot more than we’re giving up. We’re hoping that it continues but with all the financial constraints, who knows what the future is going to look like.”

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