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. Review of Blue Cross Blue Shield of Maine's Postretirement Benefit Plan (A-07-05-00196)
2. Review of Training Costs for Title IV-E Foster Care and Adoption Assistance Programs in Connecticut for State Fiscal Years 2002 Through 2004 (A-01-05-02502)
3. Review of Medicaid Support for Graduate Medical Education in Minnesota During Fiscal Year 2000 (A-05-04-00071)
4. Review of Undistributable Child Support Collections in Michigan From October 1, 1998, Through December 31, 2004 (A-05-05-00033)
5. Missouri Medicaid Payments for Skilled Professional Medical Personnel (A-07-05-03066).
6. Nursing Home Emergency Preparedness and Response During Recent Hurricanes (OEI-06-06-00020)
7. Audit of the Kentucky Medicaid Agency's Buy-In of Medicare Parts A and B (A-04-05-03003)
8. The Food and Drug Administration's National Drug Code Directory (OEI-06-05-00060)
9. Cost and Performance of Medicare's 2005 Chemotherapy Demonstration Project (OEI-09-05-00171)
10. The CIA Addendum entered into with the Schering-Plough Corporation
11. Advisory Opinion Document 06-09 concerning a nonprofit, tax-exempt, charitable organization's proposals to subsidize Medicare Part D premium and cost-sharing obligations
12. OIG announces a Federal Register Notice: Publication of OIG’s "Guidelines for Evaluating State False Claims Acts”
1. Review of Blue Cross Blue Shield of Maine's Postretirement Benefit Plan (A-07-05-00196)
The objective of their review was to determine (1) the allowability of postretirement benefit (PRB) costs Maine claimed for Medicare reimbursement for fiscal years (FY) 1992 through 2000 and (2) the Federal Government’s share of excess Medicare assets resulting from previously funded PRB costs. Maine did not claim all PRB costs that were allowable for Medicare reimbursement for FYs 1992 through 2000 because it did not claim PRB costs in accordance with the Medicare contract. Therefore, Maine underclaimed $112,044 of allowable PRB costs. The Federal Government’s share of excess Medicare assets resulting from previously funded PRB costs was $625,306. The net of these amounts, $513,262, should be remitted to the Federal Government. OIG recommended that Maine remit $513,262 to the Federal Government for excess Medicare assets resulting from previously funded PRB costs. Maine concurred with their recommendation.
For the full article, click here: http://oig.hhs.gov/oas/reports/region7/70500196.pdf
2. Review of Training Costs for Title IV-E Foster Care and Adoption Assistance Programs in Connecticut for State Fiscal Years 2002 Through 2004 (A-01-05-02502)
The objective of OIG was to determine whether Department of Children and Families (the State agency) properly claimed Federal reimbursement at the enhanced rate for Title IV-E training costs during their audit period of July 1, 2001, through June 30, 2004. The State agency overstated the Federal share of foster care and adoption assistance costs by $2.4 million by improperly claiming for: 26 training courses that should not have been charged to Title IV-E, 59 administrative courses that did not meet the requirements for enhanced reimbursement but were eligible for reimbursement at the 50-percent rate, and central office administration costs that did not meet the requirements for enhanced reimbursement but were eligible for reimbursement at the 50-percent rate.
OIG recommended that the State: (1) make a financial adjustment of $2.4 million on its next quarterly Report of Expenditures, (2) establish procedures to ensure that only qualified training expenses are claimed at the enhanced rate, and (3) review training costs for Federal reimbursement after the audit period to ensure compliance with Federal requirements. The State agency agreed with their recommendations and said it was taking appropriate corrective action.
For the full article, click here: http://oig.hhs.gov/oas/reports/region1/10502502.pdf
3. Review of Medicaid Support for Graduate Medical Education in Minnesota During Fiscal Year 2000 (A-05-04-00071)
Their objectives were to determine whether (1) Minnesota followed the approved State plan in administering the Medicaid graduate medical education program and (2) intergovernmental transfers included any funds for graduate medical education. Minnesota used $150,000 ($77,220 Federal share) for administrative expenses, although the State plan earmarked these funds for medical education. Also, contrary to Federal regulations, the State plan did not include a detailed description of the payment methodology used for the distribution of the funds to teaching hospitals. Concerning their second objective, OIG found that while there were no intergovernmental transfers involved, six hospitals had reassigned funds, totaling $15 million, back to the State. Although the reassignments were required by the State plan covering fiscal year 2000, OIG noted that this payment structure was changed (effective fiscal year 2006) to no longer allow for the reassignments.
OIG recommended that Minnesota report a $77,220 financial adjustment and coordinate with CMS to include appropriate language in the State plan to explain how the distributions of Medicaid graduate medical education funds were computed and paid to eligible hospitals and training sites.
For the full article, click here: http://oig.hhs.gov/oas/reports/region5/50400071.pdf
4. Review of Undistributable Child Support Collections in Michigan From October 1, 1998, Through December 31, 2004 (A-05-05-00033)
Their objectives were to determine whether the Michigan Department of Human Services, Office of Child Support (State agency) appropriately reported program income for undistributable child support collections and interest earned on program funds. The State agency did not recognize program income of $6,662,322 ($4,397,133 Federal share) for unclaimed collections held by Friend of the Court offices that should have been considered abandoned and transferred to the State Treasurer pursuant to State law. The State agency did not report program income totaling $390,695 ($257,859 Federal share) for undistributable child support collections that were transferred to the State Treasurer for the quarters ended December 1998 through December 2004. In addition, the State agency could not provide documentation to support resolution of a prior Office of Child Support Enforcement (OCSE) Division of Audit finding and recommendation regarding undistributable collections totaling $1,121,298 ($740,057 Federal share) that were not reported as program income.
OIG recommended that the State agency: (1) require the Friend of the Court offices to transfer the unclaimed collections to the Unclaimed Property Division and report program income for undistributable collections totaling $6,662,322 ($4,397,133 Federal share); (2) report program income for undistributable collections of $390,695 ($257,859 Federal share) that were transferred to the State Treasurer; (3) provide program oversight to ensure that undistributable collections are identified and reported as program income on the quarterly Federal financial report (Form OCSE‑396A); (4) implement adequate policies, procedures, and controls to ensure that undistributable child support collections reported on the quarterly report of collections (Form OCSE‑34A) are recognized as program income on Form OCSE‑396A; and (5) work with OCSE to resolve the recommendation from 1999 to adjust for undistributable collections totaling $1,121,298 ($740,057 Federal share) not reported as program income. The State agency generally disagreed with their findings and recommendations.
For the full article, click here: http://oig.hhs.gov/oas/reports/region5/50500033.pdf
5. Missouri Medicaid Payments for Skilled Professional Medical Personnel (A-07-05-03066)
The objective of their review was to determine if Missouri's Department of Social Services, Division of Medical Services (State agency) properly claimed payments for skilled professional medical personnel at the enhanced Federal funding rate for fiscal year (FY) 2003. OIG found that the State agency did not properly claim payments for 67 skilled professional medical personnel at the enhanced Federal funding rate for FY 2003. Specifically, the State agency claimed costs for (1) personnel in positions that did not require medical expertise, (2) personnel who did not meet the educational or licensure requirements, (3) personnel whose staff time was split between different functions, and (4) directly supporting staff who either were not supervised by skilled professional medical personnel or did not meet the definition of directly supporting staff. The State agency also improperly claimed travel expenditures at the enhanced Federal funding rate.
OIG recommended the State agency: (1) refund $525,249 to the Federal Government, (2) develop and implement policies and procedures to more closely monitor payments for skilled professional medical personnel and directly supporting staff, and (3) develop a CMS‑approved methodology to allocate costs for personnel whose staff time is split between different functions. The State agency stated that it "disagree[d] with the recommendations in the draft report that [it] do[es] not believe to be consistent with Section 1903(a)(2) of the Social Security Act or its implementing regulations." The State agency asserted that one employee cited as not meeting the education requirements was a registered nurse, but it agreed that three other employees did not meet the education requirements. It also agreed that travel costs should not have been claimed at the enhanced rate for three employees.
For the full article, click here: http://oig.hhs.gov/oas/reports/region7/70503066.htm
6. Nursing Home Emergency Preparedness and Response During Recent Hurricanes (OEI-06-06-00020)
The objectives of this study were to determine the incidence of nursing home deficiencies for lack of emergency preparedness, and for selected nursing homes in the five Gulf States, to examine their experiences during recent hurricanes and the completeness of their emergency preparedness plans. OIG reviewed State survey data, conducted onsite interviews of nursing home staff and local authorities, and compared nursing home emergency plans to a list of provisions suggested by emergency management and elder care experts.
OIG found that nationwide, 94 percent of nursing homes met Federal standards for emergency plans and 80 percent for sufficient emergency training in 2004-2005, with similar compliance rates for Gulf States.
Among selected nursing homes, OIG found that all experienced problems whether evacuating or sheltering in place. However, those that evacuated faced transportation contracts that were not honored, lengthy travel times, host facilities that were unavailable or inadequately prepared, inadequate staffing, insufficient food and water, and difficult reentry to facilities. OIG also found that nursing home administrators and staff often did not follow their emergency plans during recent hurricanes, that the emergency plans were often missing suggested provisions, and that a lack of collaboration between State and local emergency entities and nursing homes impeded emergency planning and response.
OIG recommend that CMS consider strengthening Federal certification standards for nursing home emergency plans by including requirements for specific elements of emergency planning, and that CMS encourage communication and collaboration between State and local emergency entities and nursing homes. CMS concurred with these recommendations.
For the full article, click here: http://oig.hhs.gov/oei/reports/oei-06-06-00020.pdf
7. Audit of the Kentucky Medicaid Agency's Buy-In of Medicare Parts A and B (A-04-05-03003)
The objective of their audit was to determine whether the Cabinet for Health and Family Services, Department for Medicaid Services (State Medicaid agency) paid Medicare premiums only for individuals eligible for the State buy-in program. During the conversion to a new buy-in system in 2004, the State Medicaid agency erroneously paid approximately $4 million ($2.8 million Federal share) in Medicare Part B premiums for 4,816 individuals who were not eligible for the State buy-in program.
These erroneous payments occurred because the State Medicaid agency did not adequately test changes made to its buy-in system. During the periods before and after its conversion to a new buy-in system, the State Medicaid agency generally paid Medicare premiums for individuals who were eligible for the State buy-in program. However, the State Medicaid agency inappropriately claimed $41,307 ($29,290 Federal share) in Medicare premiums for periods when nine beneficiaries were ineligible because it did not reconcile CMS's monthly Medicare premium billing files to the State Medicaid agency's eligibility records.
OIG recommended that the State Medicaid agency refund to the Federal Government: (1) $2,770,494 (Federal share) in Medicare premiums claimed for the 4,816 ineligible beneficiaries added during the buy-in system conversion period and (2) $29,290 (Federal share) in Medicare premiums claimed for the periods when the nine beneficiaries were ineligible. OIG also recommended that the State Medicaid agency adequately test all future changes to its buy-in system prior to implementation and develop internal controls to ensure that Medicare premiums are paid only for eligible individuals. In written comments to the draft report, State agency officials agreed with their findings and recommendations.
For the full article, click here: http://oig.hhs.gov/oas/reports/region4/40503003.pdf
8. The Food and Drug Administration's National Drug Code Directory (OEI-06-05-00060)
The objective of this study was to determine whether FDA's National Drug Code (NDC) Directory is a complete and accurate listing of currently marketed prescription drug products. Results show that the NDC Directory is neither complete nor accurate. An estimated 9,187 prescription drug products are missing while another 5,150 have not cleared the listing process. Further, an estimated 34,257 drug products listed are no longer on the market, or are listed in error. Problems are due primarily to drug firms' failing to report when drugs are placed on or taken off the market and failing to provide sufficient and accurate information to complete the listing process. To resolve issues of completeness and accuracy of the Directory, OIG recommends that FDA:
(1) finalize draft listing instructions referenced on its Web site,
(2) provide greater control over the assignment of NDCs,
(3) continue efforts to implement electronic submission of listing forms by firms,
(4) implement a mechanism to routinely identify drug product omissions and inaccuracies,
(5) resolve the status of currently pending drug product listings,
(6) enhance communication with drug firms to facilitate accurate and complete reporting of drug products, and
(7) identify and take appropriate action against drug firms that consistently fail to list drug products and update information.
FDA concurred with OIG's recommendations.
For the full article, click here: http://oig.hhs.gov/oei/reports/oei-06-05-00060.pdf
9. Cost and Performance of Medicare's 2005 Chemotherapy Demonstration Project (OEI-09-05-00171)
OIG estimated the total cost of the Medicare chemotherapy demonstration project by analyzing Medicare paid claims data through the end of 2005.
For OIG’s overall assessment of the demonstration, they conducted interviews with CMS staff and reviewed e-mails, meeting notes, and other workpapers that CMS submitted in response to their request for the entire project file and any supplemental documentation. OIG also interviewed staff at four oncology practices that participated in the demonstration to learn how they implemented the demonstration requirements.
OIG found that Medicare and its beneficiaries will spend approximately $275 million for the 2005 chemotherapy demonstration. Participation in the project was high; 90 percent of eligible providers took part, and approximately 85 percent billed the demonstration codes at 50 percent or more of eligible chemotherapy administration visits. Seven percent of paid demonstration claims did not comply with program rules or were paid incorrectly, resulting in $17 million in overpayments. Furthermore, because the parameters of the demonstration were not sufficiently defined, the data are unreliable.
For the full article, click here: http://oig.hhs.gov/oei/reports/oei-09-05-00171.pdf
10. The CIA Addendum entered into with the Schering-Plough Corporation.
To see that agreement: http://tinyurl.com/pkjbx
View the August 29 press release on the $435 million settlement with Schering-Plough from the U.S. Attorney in Boston here: http://tinyurl.com/r56ar
11. Advisory Opinion Document 06-09 concerning a nonprofit, tax-exempt, charitable organization's proposals to subsidize Medicare Part D premium and cost-sharing obligations
To access the Advisory Opinion document 06-09 (concerning a nonprofit, tax-exempt, charitable organization's proposals to subsidize Medicare Part D premium and cost-sharing obligations owed by financially needy patients with end-stage renal disease and chronic kidney disease) go
here:
http://oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-09.pdf
12. OIG announces a Federal Register Notice: "Publication of OIG’s "Guidelines for Evaluating State False Claims Acts"
The notice: http://oig.hhs.gov/authorities/docs/06/waisgate.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. |
