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.
1.Medicare Beneficiary Access to Skilled Nursing Facilities Under the Prospective Payment System (OEI-02-04-00270)
2. Beneficiary Access to Home Health Agencies (OEI-02-04-00260; 07/06)
3. OIG Posts Three Final Rules
4. Graduate Medical Education for Dental Residents Claimed by University of California at San Francisco Medical Center for Fiscal Years 2000 Through 2002 (A-04-04-06012)
5. Report on the Medicare Drug Discount Card Program Sponsor Public Sector Partners (A-06-05-00062)
In this issue:
1. Medicare Beneficiary Access to Skilled Nursing Facilities Under the Prospective Payment System (OEI-02-04-00270)
This report assesses Medicare beneficiaries' access to skilled nursing facilities since the implementation of the prospective payment system. This study is the most recent in a series conducted by OIG on access to skilled nursing facilities for Medicare beneficiaries since the Balanced Budget Act of 1997 required payments for skilled nursing care to be made on a prospective basis. This inspection is based on structured interviews with 256 hospital discharge planners with experience placing Medicare beneficiaries in skilled nursing facilities, and an analysis of 5 years of Medicare data for beneficiaries discharged from a hospital to a skilled nursing facility. OIG found that most Medicare beneficiaries have access to skilled nursing facilities. OIG also found that beneficiaries with certain medical conditions, such as those requiring expensive drugs or wound care, may experience delays being placed in a skilled nursing facility. OIG concluded that these findings are generally consistent with the findings in their three prior reports, suggesting that; overall, the prospective payment system has not resulted in reduced access to SNF care. OIG encourages CMS to continue to monitor access to skilled nursing care, particularly for beneficiaries with certain medical conditions or service needs who may experience delays in accessing such care.
To access the full article, click here: http://www.oig.hhs.gov/oei/reports/oei-02-04-00270.pdf
2. Beneficiary Access to Home Health Agencies (OEI-02-04-00260; 07/06)
This final report assesses Medicare beneficiaries' access to home health care since the implementation of the prospective payment system. This study is the most recent in a series conducted by OIG on access to home health care since the Balanced Budget Act of 1997 required payments for home health care to be made on a prospective basis. This inspection is based on structured interviews with 256 hospital discharge planners with experience placing Medicare beneficiaries in home health care, and an analysis of 5 years of Medicare data for beneficiaries discharged from a hospital to home health care. OIG found that most Medicare beneficiaries have access to home health care. They also found that beneficiaries with certain medical conditions, such as those needing IV antibiotics and/or expensive drugs and those who have complex wound care needs, may experience delays being placed in home health care. OIG concluded that these findings are generally consistent with the findings in their three prior reports, suggesting that; overall, the prospective payment system has not resulted in reduced access to home health care. OIG encourages CMS to continue to monitor access to home health care, particularly for beneficiaries with certain medical conditions or service needs who may experience delays in accessing such care.
To access the full article, click here: http://www.oig.hhs.gov/oei/reports/oei-02-04-00260.pdf
3. OIG Posts Three Final Rules
OIG posts a final rule on display today with the Federal Register: "Safe Harbors for Certain
Electronic Prescribing and Electronic Health Records Arrangements Under the Anti-Kickback Statute."
To get to the final OIG rule, go here:
http://oig.hhs.gov/authorities/docs/06/OIG%20E-Prescribing%20Final%20Rule%20080806.pdf
Also on display at the Federal Register is a final CMS rule concerning new exceptions under the Physician Self-Referral Law having to do with electronic prescribing and electronic health records. The CMS rule will be posted on their website, here:
http://www.cms.hhs.gov/PhysicianSelfReferral/Downloads/CMS-1303-F.pdf
Finally, the Department of Health & Human Services (of which both OIG and CMS are component agencies) issued a press release on both rules. To see that release: http://www.hhs.gov/news/press/2006pres/20060801.html
Finally, the Department of Health & Human Services (of which both OIG and CMS are component agencies) issued a press release on both rules. To see that release: http://www.hhs.gov/news/press/2006pres/20060801.html
4. Graduate Medical Education for Dental Residents Claimed by University of California at San Francisco Medical Center for Fiscal Years 2000 Through 2002 (A-04-04-06012)
Their objective was to determine whether the University of California at San Francisco Medical Center (the Hospital) included the appropriate number of dental residents in its full-time equivalent (FTE) counts when computing Medicare graduate medical education (GME) payments for fiscal years (FYs) 2000 through 2002. The Hospital overstated its direct and indirect GME claims by a total of $3,904,526 for FYs 2000 through 2002. The Hospital inappropriately included a total of 153.88 direct GME FTEs and 159.69 indirect GME FTEs in the counts for FYs 2000 through 2002.
OIG recommended that the Hospital (1) file an amended cost report, which will result in a refund of $3,904,526 associated with FTEs for which the Hospital did not incur all or substantially all of the training costs; (2) establish and follow written procedures to ensure that the FTE counts for residents in nonhospital settings include only those FTEs for which the Hospital has incurred all or substantially all of the training costs; and (3) determine whether errors similar to those identified in their review occurred in Medicare cost reports after FY 2002 and refund any overpayments. The Hospital generally disagreed with their findings and recommendations.
To access the full article, click here: http://www.oig.hhs.gov/oas/reports/region4/40406012.pdf
5. Report on the Medicare Drug Discount Card Program Sponsor Public Sector Partners (A-06-05-00062)
The objectives of their review were to determine whether Public Sector Partners (PSP) complied with Federal requirements to (1) ensure that beneficiaries did not exceed their transitional assistance (TA) limits, (2) apply TA funds only to covered drugs, (3) pass on negotiated prices to beneficiaries and offer the lower of the negotiated prices or the usual and customary prices, and (4) support the expenditures and withdrawals it reported to CMS. PSP properly supported the expenditures it made on behalf of beneficiaries and the withdrawals from the Payment Management System. However, PSP did not have proper procedures in place to ensure that it always complied with Federal requirements to ensure that beneficiaries did not exceed their TA fund limits, apply TA funds only to covered drugs, and pass on negotiated prices to beneficiaries and charge the lower of the negotiated prices or the usual and customary prices. As a result, CMS overpaid PSP $420,875 for beneficiaries who exceeded their TA limits and $231,260 for excluded drugs for the period July 12, 2004, through May 31, 2005. In its written comments on their draft report, PSP agreed that errors had occurred, but it did not agree with all of the causes OIG identified. PSP stated that it had worked with CMS to correct its procedures and had reimbursed CMS for the errors OIG identified.
OIG recommended that PSP: (1) reimburse CMS for the $420,870; (2) determine whether the amount PSP reimbursed CMS for excluded drugs included any of the $231,620 identified in the audit and reimburse the difference; and (3) implement policies and procedures, if it continues as a prescription drug plan sponsor to ensure that it (a) does not pay for statutorily excluded drugs with CMS funds and (b) offers negotiated prices to beneficiaries.
To access the full article, click here: http://www.oig.hhs.gov/oas/reports/region6/60500062.pdf
For the List of Excluded Individuals/Entities (LEIE), follow this link:
http://oig.hhs.gov/fraud/exclusions/listofexcluded.html
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. |
