A biweekly publication from the Healthcare Group at Feeley & Driscoll, P.C.
Please visit us at our website: www.fdcpa.com/healthcare.htm. This OIG Update is also accessible from the F&D website, by visiting www. fdcpa.com/oig.updates.htm.
In This Issue:
1. OIG Posts a New Advisory Opinion to the Website
2. Review of Medicare Prescription Drug, Improvement, and Modernization Act Modifications to Calendar Year 2004 Proposal - Horizon Healthcare of New Jersey, Inc. (A-02-05-01015)
3. Medicaid Hospital Outlier Payments in New York for State Fiscal Years 1998 through 2002 (A-02-04-01022)
4. Audit of Cost Transfers Funded Under NIH Grants at the University of Chicago (A-05-05-00047)
5. Review of Medicaid School-Based Services in Kansas-Bundled Rate Development (A-07-05-01018)
6. Emergency Response to Hurricanes Katrina and Rita: Audit of Program Support Center's Procurement Process for Contract Action HHSP233200600085U With Analytic Services, Inc. (A-03-06-00511)
7. Medicaid Payments for Beneficiaries with Concurrent Eligibility in Ohio and Michigan, Ohio Department of Job and Family Services (A-05-06-00021)
8. FDA's Monitoring of Postmarketing Study Commitments (OEI-01-04-00390; 06/06)
9. Testimony of Robert Vito, Regional Inspector General for Evaluation and Inspections
In This Issue:
1. OIG Posts a New Advisory Opinion to the Website
To access the Advisory Opinion document, 06-08 (concerning a free clinic's practice of dispensing drugs on behalf of patient assistance programs ("PAPs") sponsored by pharmaceutical manufacturers that provide free drugs to financially-needy patients, including some patients enrolled in the Medicare Part D outpatient prescription drug benefit) go here: http://www.oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-08LheadE.pdf
2. Review of Medicare Prescription Drug, Improvement, and Modernization Act Modifications to Calendar Year 2004 Proposal - Horizon Healthcare of New Jersey, Inc. (A-02-05-01015)
The objective of their review was to determine whether Horizon Healthcare of New Jersey, Inc.'s (Horizon's) use of its MMA payment increase was adequately supported and allowable under MMA. Horizon's use of its MMA payment increase was adequately supported and allowable under the MMA. Horizon appropriately used the increased Medicare capitation payments to reduce beneficiary premiums, enhance benefits, and stabilize and enhance beneficiary access to providers. Specifically, Horizon eliminated beneficiary premiums, enhanced benefits by adding vision and prescription benefits, and increased capitation payments to primary care providers. Therefore, OIG did not make any recommendations.
To access the full article click here: http://www.oig.hhs.gov/oas/reports/region2/20501015.pdf
3. Medicaid Hospital Outlier Payments in New York for State Fiscal Years 1998 through 2002 (A-02-04-01022)
Their objective was to determine whether the New York State Department of Health's method of computing inpatient hospital cost outlier payments resulted in reasonable payments. With one exception, New York's method of computing inpatient hospital cost outlier payments generally resulted in reasonable payments. New York did not use the most accurate cost-to-charge ratios to convert billed charges to costs. Had it done so, New York could have saved approximately $21.5 million ($10.75 million Federal share) in cost outlier payments between State fiscal years 1998 and 2002 at the three hospitals that OIG reviewed.
OIG recommended that New York amend its State plan to require retroactive adjustments of interim cost outlier payments based on cost report data for the year in which the inpatient discharge occurred. New York concurred with their recommendation, but stated that implementation would require changes in State regulations and the applicable State plan. (June 19, 2006)
To access the full article click here: http://oig.hhs.gov/oas/reports/region2/20401022.htm
4. Audit of Cost Transfers Funded Under NIH Grants at the University of Chicago (A-05-05-00047)
The objectives of the audit were to determine whether the University (i) developed and implemented adequate written procedures and controls relating to cost transfers and (ii) justified and supported cost transfers in accordance with Federal regulations and the institution's policies and procedures. Although the University developed and implemented adequate written policies and procedures and controls relating to cost transfers and generally justified and supported cost transfers to NIH grants, staff did not always follow those procedures and cost transfers were not always documented and authorized as required. OIG found that one transfer lacked required documentation to explain how the error occurred and four late transfers were made without completing or properly authorizing the required form for University oversight and approval. Sufficient justification and documentation were ultimately available to support the allowability and allocability of the cost transfers to NIH grants. OIG recommended that the University reemphasize cost transfer policies and procedures with the Comptroller's and departmental staff. The University agreed with their recommendation.
To access the full article click here: http://www.oig.hhs.gov/oas/reports/region5/50500047.pdf
5. Review of Medicaid School-Based Services in Kansas-Bundled Rate Development (A-07-05-01018)
OIG’s objective was to determine whether Kansas developed the payment rates for Medicaid school-based health services pursuant to Federal requirements and the State plan. Kansas did not develop the payment rates for Medicaid school-based health services pursuant to Federal requirements and the State plan. Kansas used incorrect indirect cost rates and service utilization data to develop the payment rates. The payments to school districts for FYs 1998-2003 were incorrect, and Kansas received $18.5 million of overpayments.
OIG recommended that Kansas refund $18.5 million to the Federal Government, calculate and refund all overpayments that occurred subsequent to their audit period, and develop and implement adequate internal controls to ensure that future Federal claims for school-based services are consistent with Federal requirements and the State plan. In its comments on their draft report, Kansas concurred with the findings and two of the recommendations. Kansas did not address their recommendation to calculate and refund all overpayments that occurred subsequent to their audit period.
To access the full article click here: http://www.oig.hhs.gov/oas/reports/region7/70501018.pdf
6. Emergency Response to Hurricanes Katrina and Rita: Audit of Program Support Center's Procurement Process for Contract Action HHSP233200600085U With Analytic Services, Inc. (A-03-06-00511)
The objective of their audit was to determine whether the Program Support Center (PSC) complied with applicable Federal Acquisition Regulations and Health and Human Services Acquisition Regulation while making the involved procurement. PSC procurement officials complied with Federal acquisition requirements during the award process of $15,827,324 for the contract action HHSP233200600085U under contract number GS10F0026J, to Analytic Services, Inc., for provision of services to hurricane victims. Because this report contained no recommendations, no response was necessary.
To access the full article click here: http://www.oig.hhs.gov/oas/reports/region3/30600511.pdf
7. Medicaid Payments for Beneficiaries with Concurrent Eligibility in Ohio and Michigan, Ohio Department of Job and Family Services (A-05-06-00021)
The objective of their audit was to determine the appropriateness of Medicaid payments made by the State of Ohio for beneficiaries who were concurrently listed as Medicaid eligible in both Ohio and Michigan. OIG found that the Ohio Medicaid program inappropriately paid $333,716 for 471 Medicaid beneficiaries who had established eligibility in both States but should only have been eligible in Michigan. OIG did not determine the appropriateness of an additional $56,171 of payments made during the first month of concurrent eligibility because Ohio considers the beneficiary eligible for the full month once eligibility is established any time during the month. OIG recommended that the Ohio Department of Job and Family Services (State agency): (1) seek recovery of inappropriate payments, estimated to be $333,716 ($196,325 Federal share), and refund the Federal share of recovered amounts; (2) review claims made in the first month of concurrent eligibility and determine whether the payments are allowable; and (3) consider additional procedures for identifying beneficiaries moving out of State, including participation in the Public Assistance Reporting Information System (PARIS) project and increased sharing of eligibility information with the other State Medicaid programs. Ohio officials agreed to perform additional work to determine the allowability of reported inappropriate payments. The State agency will consider additional procedures and participation in PARIS based on the results of their review. (June 23, 2006)
To access the full article click here: http://oig.hhs.gov/oas/reports/region5/50600021.htm
8. FDA's Monitoring of Postmarketing Study Commitments (OEI-01-04-00390; 06/06)
FDA requires all new drugs to undergo clinical testing to demonstrate their safety and efficacy prior to approval for sale in the United States. After a drug has been approved for marketing, drug applicants can learn more about the risks, benefits, and optimal use of a drug that has been approved by conducting postmarketing studies. These studies have become increasingly common in recent years, and Congress and others have raised concerns that these studies are not being completed in a timely manner. Between fiscal years 1990 and 2004, 48 percent of new drug applications involved at least one postmarketing study commitment. OIG identified vulnerabilities that raise concerns that FDA is not able to readily identify whether or how timely postmarketing study commitments are progressing toward completion. OIG found that about one-third of annual status reports (ASRs) were missing or incomplete, and that ASRs contain information that is of limited utility. OIG also found limitations associated with the management information system for monitoring postmarketing study commitments. Further, OIG found that monitoring postmarketing study commitments is not a top priority at FDA. To address these vulnerabilities, FDA should (1) instruct drug applicants to provide additional, meaningful information in their ASRs; (2) improve the management information system for monitoring postmarketing study commitments; and (3) ensure that postmarketing study commitments are being monitored and that ASRs are being validated. FDA concurred with the second and third recommendation, but did not concur with the first recommendation.
To access the full article click here: http://oig.hhs.gov/oei/reportsh/oei-01-04-00390.pdf
9. Testimony of Robert Vito, Regional Inspector General for Evaluation and Inspections
On July 13, Vito appeared before the Subcommittee on Health of the U.S. House Committee on Ways and Means on Medicare Part B Prescription Drug Reimbursements. To get to the testimony:
http://oig.hhs.gov/testimony/docs/2006/60713fin.pdf
For the index of recent OIG Advisory Opinions, follow this link: http://oig.hhs.gov/fraud/advisoryopinions/opinions.html
To see "Frequently Asked Questions" (FAQs) on the OIG Advisory Opinion process, go here: http://oig.hhs.gov/fraud/advisoryopinions/aofaq.htm
For more information regarding the OIG's Exclusion Program, please follow this link: http://oig.hhs.gov/fraud/exclusions.html
If you have any questions or would like to discuss any of these issues with one of Feeley & Driscoll’s healthcare specialists, please contact us at (617) 742-7788 or via e-mail at info@fdcpa.com. |
