From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Fri, Aug 15, 2014 at 9:52 AM
Subject: OIG posts 4 reports, news about enforcement actions and a correction notice - 8/15
To: iammejtm@gmail.com
Good afternoon from Washington, DC. Today OIG posts 4 reports, an Advisory Opinion, news about enforcement actions and a report correction. As always, you can use the links provided to go directly to the new material.
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Some Maine Child Day Care Centers Did Not Always Comply With State Health and Safety Licensing Requirements (A-01-13-02503) http://go.usa.gov/EWB5
Although the Maine Department of Health and Human Services' (State agency) licensing division conducted the required inspections at all six of the providers that we reviewed, this onsite monitoring did not ensure that providers that received Child Care and Development Funds complied with State licensing requirements related to the health and safety of children. We determined that the six providers did not comply with one or more State licensing requirements to ensure the health and safety of children. Specifically, we found that all six of the providers did not always comply with State licensing requirements related to the physical conditions of child day care centers, five of the providers did not always comply with inspection procedures or other administrative requirements, and four of the providers did not comply with requirements to obtain criminal history and child protection reports. We recommend that the State agency work with the State licensing agency to:
Ensure through more frequent and thorough onsite monitoring that providers comply with health and safety requirements,
Consider State regulatory changes to ensure unannounced inspections are required to be conducted at least annually,
Ensure adequate oversight by reducing licensing inspectors' caseloads, and
Ensure that providers obtain criminal history and child protection reports for all employees who provide direct services to children.
In written comments on our draft report, the State agency generally concurred with our findings and explained its plans for addressing our recommendations.
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Some Maine Family Child Day Care Home Providers Did Not Always Comply With State Health and Safety Licensing Requirements (A-01-13-02507) http://go.usa.gov/EWZw
The Maine Department of Health and Human Services' licensing division (State licensing division) conducted the required inspections at 18 of the licensed family child day care home providers (providers) that we reviewed, but it did not conduct the required inspections at 2 of the providers until more than 18 months before our inspections. The State licensing division's onsite monitoring did not always ensure that providers that received Child Care and Development Funds complied with State licensing requirements related to the health and safety of children. We determined that 16 of the providers did not comply with 1 or more State licensing requirements to ensure the health and safety of children. Specifically, we found that 14 providers did not comply with requirements related to the physical conditions of their facilities, 10 providers did not comply with inspection procedures and other administrative requirements, and 5 providers did not comply with requirements to obtain criminal history and child protection reports.
We recommended that the State agency:
(1) Ensure through more frequent and thorough onsite monitoring that providers comply with health and safety requirements;
(2) Consider State regulatory changes to ensure unannounced inspections are required to be conducted at least annually;
(3) Ensure adequate oversight by reducing licensing inspectors' caseloads; and
(4) Ensure criminal history and child protection reports are obtained for each individual applicant; paid, unpaid, temporary, or regular staff member or volunteer; and any adult living in or frequenting the premises.
The State agency generally concurred with our findings and explained its plans for addressing our recommendations.
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California Improperly Claimed Enhanced Federal Reimbursement for Medicaid Family Planning Services Provided in Southeast Los Angeles County (A-09-13-02047) http://go.usa.gov/EWZY
The California Department of Health Care Services (State agency) did not always comply with certain Federal requirements when claiming Federal reimbursement at the 90-percent rate for family planning services provided under the Family Planning, Access, Care, and Treatment (FPACT) program in southeast Los Angeles County. On the basis of our sample results, we estimated that the State agency claimed approximately $2.3 million unallowable Federal reimbursement.
The overpayment occurred because the State agency did not have billing procedures to ensure that it claimed reimbursement at the 90 percent rate only for services clearly provided for family planning purposes. Also, the State agency's Medicaid Management Information System (MMIS) lacked edits to prevent family-planning-related services from being claimed at the 90 percent rate.
We recommended that the State agency:
(1) Refund approximately $2.3 million to the Federal Government,
(2) Establish billing procedures to ensure that only services clearly provided for family planning purposes are claimed for reimbursement at the 90-percent rate, and
(3) Establish MMIS edits to ensure that FPACT claims meet Federal and State requirements for reimbursement at the 90-percent rate and at the regular FMAP for family-planning-related services.
The State agency agreed with our recommendations.
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Memorial Sloan-Kettering Cancer Center Claimed Federal Reimbursement for Unallowable Extramural Construction Costs Related to a National Institutes of Health Recovery Act Grant (A-02-12-02013) http://go.usa.gov/EWBV
Memorial Sloan-Kettering Cancer Center (Sloan-Kettering) claimed unallowable extramural construction costs related to a National Institutes of Health (NIH) Recovery Act grant totaling $126,000. Specifically, Sloan-Kettering claimed costs for the construction of a tunnel/service corridor ($121,000) and moving services ($5,500) that did not benefit the grant. Sloan-Kettering met all Recovery Act and NIH reporting requirements and milestone dates for project completion. We recommended that NIH require Sloan-Kettering to refund $126,000 to the Federal Government.
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Advisory Opinion 14-06 http://go.usa.gov/EZqd This Advisory Opinion concerns a specialty pharmacy's proposal to pay local retail pharmacies a fee for support services they provide in connection with patient referrals to the specialty pharmacy
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August 14, 2014; U.S. Attorney; Southern District of Georgia Government Settles False Claims Act Allegations against Optim Healthcare http://go.usa.gov/NXZP
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August 14, 2014; U.S. Attorney; District of Massachusetts Former Tufts Health Plan Employee Convicted of Disclosing Personal Patient Information http://go.usa.gov/NXZP
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August 13, 2014; U.S. Attorney; Middle District of Georgia Middle Georgia Tax Preparer Sentenced http://go.usa.gov/NXZP
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State Enforcement Actions Updated http://go.usa.gov/NXWh
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Correction Notice: OIG posted a corrected version of Questionable Billing for Medicare Part B Clinical Laboratory Services (OEI-03-11-00730) http://go.usa.gov/EWBh. This report was originally issued on July 8, 2014. OIG discovered that the report contained computational errors, and we have corrected those errors – please use this version. The earlier report stated that Medicare allowed $1.7 billion for questionable claims for laboratory services in 2010 – the correct amount is $1.5 billion. The earlier report also stated that the number of laboratory service providers that exceeded the thresholds for five or more measures of questionable billing was 1,032 – the correct number is 1,025.
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Jeremy Tobias Matthews
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