A recent decision by the U.S. Supreme Court is one example of the government trying to spend less on graduate medical education, said Dr. Hagop Mekhjian, medical director of Ohio State University Medical Center.The Regions Hospital v. Donna E. Shalala decision, which was announced Feb. 24, allows the benefits reimbursed to teaching hospitals since 1984 to be reevaluated. The review could affect the amount of money hospitals will receive in the future.Justice Ruth Bader Ginsburg, who wrote the opinion for the case, said the Secretary of Health and Human Services’ re-audit rule was a reasonable request in order “to ensure accurate future reimbursements” to teaching hospitals nationwide.”I really think this may lower reimbursements for certain teaching hospitals,” Mekhjian said. He said he was not sure how the College of Medicine will be affected by the decision.At the end of each fiscal year, teaching hospitals prepare a cost report. After the report is evaluated, the Secretary of Health and Human Services lets the hospital know how much it will be reimbursed, said Chad Carpenter, reimbursement manager for the OSU Medical Center.If an agreement cannot be made on the amount of the reimbursement, the matter is taken to a review board, which acts like a court. If the board rules in favor of the hospital, Medicare has to pay the difference, Carpenter said.Only cost reports that are still open can be evaluated, he said. For example, the hospital Medicare report for fiscal year 1997 was filed in December. The report will not be audited until 1999, staying open until 2002.”But we don’t have a lot of open cost reports,” he said. “I don’t feel that we have any significant exposure. Some hospitals have large sums of money at risk because their reports are still open.”Interns and residents sometimes work in clinics outside of the hospital. This work cannot be included in the cost report, Carpenter said. “The government doesn’t feel a need to pay because the interns are not contributing to our expenses,” he said.