From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Wed, Jun 25, 2014 at 7:15 AM
Subject: OIG posts congressional testimony, 4 reports and news about enforcement actions - 6/25
To: iammejtm@gmail.com
Good morning from Washington, DC. Today OIG posts congressional testimony, four reports and news about enforcement actions. As always, you can use the links provided to go directly to the new material.
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Medicare Program Integrity: Screening Out Errors, Fraud, and Abuse http://go.usa.gov/9EX4
Gary Cantrell, Deputy Inspector General for Investigations testifies before the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations.
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The Fraud Prevention System Identified Millions in Medicare Savings, but the Department Could Strengthen Savings Data by Improving Its Procedures (A-01-13-00510) http://go.usa.gov/9ECB
The Small Business Jobs Act of 2010 (the Act) requires OIG to certify the actual and projected savings with respect to improper payments recovered and avoided and the return on investment related to the Department's use of the Fraud Prevention System (FPS) for each of its first 3 implementation years. In addition, the Act requires OIG to determine whether the Department should continue, expand, or modify its predictive analytics technologies. This report fulfills our responsibilities for the second implementation year.
In the second implementation year of the FPS, the Department has complied with the requirements of the Act for reporting actual and projected savings in the Medicare fee-for-service program and the return on investment from the use of predictive analytics technologies. Specifically, we certify that the Department's use of its FPS resulted in $54.2 million of actual and projected savings to the Medicare fee-for-service program and a return on investment of $1.34 for every dollar spent on the FPS. We also certify the $210.7 million in unadjusted savings that the FPS identified.
This year, the Department developed adjustment factors to estimate FPS savings more precisely. The $54.2 million in certified actual and projected savings was calculated by applying the adjustment factors to the $210.7 million in certified unadjusted savings that the FPS identified. The Department identified additional savings that we were unable to certify because the documentation did not support that FPS information contributed to the administrative action.
The Department's ongoing use of the FPS will strengthen efforts to prevent fraud, waste, and abuse in the Medicare fee-for-service program. The Department's use of the FPS generated a positive return on investment, and the Department continues to refine its fraud detection models using its governance process and applicable OIG recommendations to increase savings. The Department has expanded the use of the FPS nationwide to identify fraud, waste, and abuse in the Medicare fee-for-service program and is evaluating whether to expand the use of the FPS in Medicaid. However, although the Department has made significant progress in addressing the challenges of measuring actual and projected savings, its procedures were not always sufficient to ensure that its contractors provided and maintained reliable data to always support FPS savings.
To help increase savings and improve its reporting on savings measures, we recommended that the Department:
(1) Provide contractors with written instructions on how to determine when savings from an administrative action should be attributed to the FPS and (2) Require contractors to maintain documentation to support how FPS information contributes to an administrative action.
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Inconsistencies in States' Reporting of the Federal Share of Medicaid Drug Rebates (A-06-13-00001) http://go.usa.gov/9E5C
Even though States claimed drug expenditures at higher Federal financial participation (FFP) rates, they did not consistently report the Federal share of drug rebates at those higher FFP rates for one or more quarters during the period July 1, 2011 through June 30, 2012. Additionally, States used different methodologies to determine the Federal share of drug rebates.
CMS has not issued specific national guidance that instructs States to report drug rebates at the FFP rates at which drugs were originally reimbursed or that identifies acceptable methods to determine the Federal share of drug rebates. Only seven States indicated that they had received written guidance from a CMS Regional Office. Inconsistent reporting and different methodologies could lead to underreporting of the Federal share of drug rebates on the CMS-64 report and to a loss of Federal share.
We recommended that CMS issue guidance that clearly instructs States to report drug rebates at the applicable FFP rates and identify acceptable methods to determine the Federal share of drug rebates. CMS concurred with our recommendation.
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The Office of Community Services Did Not Fully Comply With Federal Monitoring and Reporting Requirements for the Community Services Block Grant Program (A-01-13-02505) http://go.usa.gov/9EXk
The Administration for Children and Families (ACF), Office of Community Services (OCS), did not fully comply with Federal monitoring and reporting requirements for the Community Services Block Grant (CSBG) program for Federal fiscal years (FYs) 2010 through 2012. Specifically, although OCS issued five final State evaluation reports since October 2011, it had a backlog of nine final reports that it had not issued to the States as of December 17, 2013. On average, OCS issued final State evaluation reports in excess of 2 years after it concluded related site visits.
In addition, OCS did not issue an annual CSBG report to Congress in 2012. OCS issued the FY 2008 and FY 2009 annual CSBG reports to Congress in June 2011 and July 2013, respectively; however, OCS has not issued the FY 2010 and FY 2011 annual CSBG reports to Congress and, therefore, has not reported on the results of State evaluations for these years. For the previous three CSBG annual reports issued to Congress, it took OCS an average of more than 3 years from the time the report preparation began to when Congress received the final report.
OCS policies, procedures, and internal controls were not adequate to ensure that OCS performed its monitoring and reporting responsibilities in an efficient and effective manner according to Federal requirements.
We recommended that ACF:
(1) Issue all delayed evaluation reports to State agencies and annual CSBG reports to Congress expeditiously,
(2) Strengthen and implement policies and procedures to establish accountability and specific timeframes for each step of report preparation and issuance,
(3) Incorporate specific data submission deadlines in cooperative agreements with vendors providing critical information used in the preparation of the OCS CSBG annual report to Congress,
(4) Strengthen and implement controls to ensure full compliance with CSBG Act monitoring and reporting requirements, and
(5) Ensure management stability and communication to oversee the effective implementation of the recommendations from GAO's 2006 report and this review.
In written comments on our draft report, ACF stated that it has issued in final all of the delayed evaluation reports that we identified in our review. In addition, ACF detailed the corrective actions it has taken to address our recommendations.
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Medicare Compliance Review of University of Washington Medical Center (A-09-13-02049) http://go.usa.gov/9E5d
University of Washington Medical Center (the Medical Center), located in Seattle, Washington, complied with Medicare billing requirements for 94 of the 157 inpatient claims we reviewed. However, the Medical Center did not fully comply with Medicare billing requirements for the remaining 63 claims, resulting in net overpayments of approximately $2.2 million for calendar years (CYs) 2010 through 2012 (60 claims) and CY 2013 (3 claims). These overpayments occurred primarily because the Medical Center did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.
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June 24, 2014; U.S. Department of Justice Owner of Home Health Company Pleads Guilty to Role in $6.5 Million Health Care Fraud Scheme http://go.usa.gov/8d3Q
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June 24, 2014; U.S. Attorney; Southern District of New York Six Charged In Manhattan Federal Court for Operating Illegal Prescription Drug Ring Out Of Bronx Grocery Store http://go.usa.gov/8d3Q
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June 23, 2014; U.S. Attorney; Western District of Arkansas $4 Million Recovery in Dr. Stacey Johnson Matter http://go.usa.gov/8d3Q
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June 23, 2014; U.S. Attorney; District of Maine Guatemalan Man Sentenced to 16 Months for Fraud http://go.usa.gov/8d3Q
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State Enforcement Actions Updated http://go.usa.gov/8d3e
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That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov
I hope your week is going well.
Marc Wolfson – Office of External Affairs
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Jeremy Tobias Matthews
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