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. Review of the Maine Claims Management System (A-01-05-00007)
2. Review of Durable Medical Equipment Providers' Medicaid Claims for NY Residents of Assisted Living Programs (A-02-05-01017)
3. State Agency Use of Contracted Services in Hamilton County - Ohio Department of Job and Family Services (A-05-05-00058)
4. Review of Arkansas’s Reporting of Medicaid Overpayments Collected by Contractors (A-06-06-00023)
5. Review of Pension Costs Claimed for Medicare Reimbursement by Blue Cross Blue Shield of Arizona for Fiscal Years 1991 Through 2005 (A-07-06-00216)
6. OIG Posts the Fiscal Year 2007 Work Plan to the Website
7. OIG Posts the Fiscal Year 2004/2005 Medicaid Fraud Control Unit Annual Report
8. Nationwide Review of Inpatient Rehabilitation Facilities' Compliance With Medicare's Transfer Regulation (A-04-04-00008)
9. Audit of Whitman-Walker Clinic's Adequacy of Patient Care (A-03-05-00207)
10. Review of Administrative Costs for Community Mental Health Centers in Indiana (A-05-04-00081)
11. Review of Medicaid School-Based Administrative Costs in Minnesota From July 1, 2003, Through June 30, 2004 (A-05-05-00040)
1. Review of the Maine Claims Management System (A-01-05-00007)
OIG’s objective was to determine whether the State agency had effective controls to ensure that claims processed and adjudicated through the Maine Claims Management System (MECMS) from January 21, 2005, through December 31, 2005, were in compliance with Medicaid requirements. OIG found the State agency did not establish effective controls to ensure that Medicaid claims were processed correctly and paid appropriately, and that all claim-related expenditures were reported accurately for Federal reimbursement.
OIG recommended the State agency reprocess all claims processed through MECMS after the CMS certifies the system; continue to reconcile interim payments; maintain supporting documentation; continue to ensure all MECMS claims processing and reporting controls are implemented; ensure that MECMS reporting controls adequately identify overpayments related to third party liability and over-utilization of services; ensure that all overpayments are reported within 60 days of discovery; and submit quarterly data from its Medicaid Statistical Information System to CMS after reprocessing the claims. The State agency generally concurred with OIG’s recommendations except for the recommendation to reprocess all claims after CMS certifies the system.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region10/10500007.pdf
2. Review of Durable Medical Equipment Providers' Medicaid Claims for NY Residents of Assisted Living Programs (A-02-05-01017)
OIG’s objective was to determine whether durable medical equipment (DME) providers improperly received Medicaid reimbursement for medical supplies and equipment not requiring prior approval that were already included in the per diem rates paid to assisted living programs (ALPs).
New York prohibits Medicaid payments to DME providers for items furnished by a facility or organization when the cost of those items is already included in the per diem rate. The DME providers improperly received Medicaid reimbursement for medical supplies and equipment not requiring prior approval that were furnished to ALP residents. As a result, $406,081 in Federal funds was improperly claimed under the Medicaid program. OIG’s report recommended that the State: (1) refund $406,081 to the Federal Government, (2) establish eMedNY edits and controls necessary to deny DME provider claims for Medicaid reimbursement for medical supplies and equipment not requiring prior approval that were furnished to ALP residents, and (3) issue guidance to DME providers emphasizing that State regulations prohibit Medicaid payment for items included in the ALPs' per diem rates. The State generally concurred with all three recommendations
To access the full article, click here: http://oig.hhs.gov/oas/reports/region2/20501017.pdf
3. State Agency Use of Contracted Services in Hamilton County - Ohio Department of Job and Family Services (A-05-05-00058)
The objectives of OIG’s audit were to review State agency oversight procedures for child support enforcement program contracts and determine the allowability of contracted services costs for the Title IV-D child support enforcement program administered by the Hamilton County Department of Job and Family Services for the period January 1, 2003, through December 31, 2004. The State agency had extensive policies and procedures in place for properly procuring contracted services for the child support enforcement program. OIG found that reviewed charges to the Title IV-D program were generally acceptable. OIG recommend that the State agency continue to emphasize its policies and procedures to ensure that County agency allocations for contracted services for the child support enforcement program are in accordance with benefits received.
State agency officials agreed with the findings and the recommendation.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region5/50500058.pdf
4. Review of Arkansas’s Reporting of Medicaid Overpayments Collected by Contractors (A-06-06-00023)
OIG’s objective was to determine whether the Arkansas Department of Health and Human Services (the State agency) reported overpayments collected by contractors in accordance with Federal requirements. The State agency did not report overpayments collected by contractors in accordance with Federal requirements during the period October 1, 2000, through April 30, 2005.
Specifically, the State agency did not report $3,657,402 ($2,732,897 Federal share) in overpayments and did not report $6,575,449 ($4,858,415 Federal share) in overpayments in a timely manner. Also, the State agency not report the Federal share of any interest earned on funds held in the cash holding account.
OIG recommended that the State agency: (1) include the $3,657,402 in unreported overpayments on the CMS-64 and refund the $2,732,897 Federal share; (2) determine the Federal share of any interest earned on the $10.2 million that was held, or still may be held, in the cash holding account and refund that amount on the CMS-64; and (3) adhere to its written procedures for clearing cash holding accounts to ensure that all future overpayments are reported in accordance with Federal requirements. The State agency agreed with OIG’s recommendations.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region6/60600023.pdf
5. Review of Pension Costs Claimed for Medicare Reimbursement by Blue Cross Blue Shield of Arizona for Fiscal Years 1991 Through 2005 (A-07-06-00216)
The objective of OIG’s review was to determine the allowability of pension costs claimed by Arizona for Medicare reimbursement for fiscal years (FY) 1991 through 2005. OIG found that Arizona claimed $142,343 of unallowable Medicare pension costs for FYs 1991 through 2005 due to the differences in the calculated allocable pension costs. Arizona claimed $1,737,918 of pension costs for Medicare reimbursement; however OIG calculated the allowable Medicare pension costs during this period to be $1,595,575. OIG recommended that Arizona revise its Final Administrative Cost Proposals for FYs 1991 through 2005 to reduce its claimed pension costs by $142,343. Arizona agreed with OIG’s recommendation.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region7/70600216.pdf
6. OIG Posts the Fiscal Year 2007 Work Plan to the Website.
The OIG Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General.
The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; and the Administrations for Children and Families, and on Aging. Information is also provided on projects related to issues that cut across departmental programs, including State and local government use of Federal funds, as well as the functional areas of the Office of the Secretary. Some of the projects described in the Work Plan are statutorily required, such as the audit of the Department's financial statements, which is mandated by the Government Management Reform Act.
For all of the above reasons, it is very difficult to provide additional details on jobs to be undertaken or information on the status of jobs contained in this Work Plan. Similarly, because of changing workloads and delays that inevitably occur during each project, OIG is not able to provide more specifics on issue date beyond that contained in each Work Plan report summary.
To access the full article, click here: http://oig.hhs.gov/publications/docs/workplan/2007/Work%20Plan%202007.pdf
7. OIG Posts the Fiscal Year 2004/2005 Medicaid Fraud Control Unit Annual Report.
The enactment of the Medicare and Medicaid Anti-Fraud and Abuse Amendments of 1977 authorized the establishment of, and Federal funding for, the State Medicaid Fraud Control Units (SMFCUs). Currently, 47 States and the District of Columbia participate in the Medicaid fraud control grant program through their established SMFCU. The majority of the Units are located within the Office of State Attorneys General. A small number of the Units are located in various other State Agencies.
The mission of the Medicaid fraud units is to investigate and prosecute Medicaid provider fraud and incidences of patient abuse and neglect.
The Inspector General is delegated the authority to annually certify each SMFCU as eligible to receive Federal grant funds under the Medicaid fraud control program. The Medicaid fraud units receive 90 percent Federal funding for the first 3 years of operation and 75 percent thereafter. A primary goal of the OIG is to ensure that each unit fully complies with all Federal regulations governing the functions and operations of a Medicaid fraud unit.
To access the full article, click here: http://oig.hhs.gov/publications/docs/mfcu/MFCU%202004-5.pdf
8. Nationwide Review of Inpatient Rehabilitation Facilities' Compliance With Medicare's Transfer Regulation (A-04-04-00008)
OIG’s objective was to determine whether inpatient rehabilitation facilities (IRFs) coded claims as "discharged to home" in compliance with Medicare's transfer regulation during fiscal year (FY) 2003. IRFs did not always code claims in compliance with Medicare's transfer regulation. Nationwide OIG identified 2,473 IRF claims coded and paid as discharges to home that potentially should have been paid as transfers.
OIG visited or contacted seven IRFs that were responsible for 112 of these claims and found that all 112 claims should have been coded as transfers rather than as discharges.
OIG recommended that CMS: (1) instruct the fiscal intermediaries to review the claims in question and to recover, as appropriate, the estimated $11,967,555 in potential overpayments, (2) instruct the fiscal intermediaries to review claims paid after OIG’s audit period for possible coding errors like those found in this review, and (3) implement edits in the Common Working File that match beneficiary discharge dates with admission dates to other providers to identify potentially miscoded claims. CMS concurred with the recommendations and requested that OIG furnish the necessary data to initiate recovery of the overpayments. OIG has provided CMS with the requested data.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region4/40400008.pdf
9. Audit of Whitman-Walker Clinic's Adequacy of Patient Care (A-03-05-00207)
OIG’s objective was to determine if an allegation submitted to the Office of Inspector General that the Whitman-Walker Clinic conducted medically unnecessary and time-consuming testing procedures that contributed to the medical deterioration and eventual death of an AIDS patient could be substantiated. There was no evidence to substantiate the allegation.
The tests performed for the patient were both necessary as a basis for treatment and conducted within acceptable timeframes. Accordingly, there were no recommendations as a result of this audit.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region3/30500207.pdf
10. Review of Administrative Costs for Community Mental Health Centers in Indiana (A-05-04-00081)
OIG’s objective was to determine whether Medicaid administrative costs incurred by community mental health providers in Indiana were claimed and paid in accordance with applicable State and Federal regulations.
Federal reimbursement for the Medicaid Recovery Program was overstated by $328,151 (Federal share) for fiscal year 2003. OIG’s review of Indiana’s program oversight disclosed $223,244 in unrecovered net provider overpayments that had previously been identified through State audits, offset by $44,590 of underclaimed provider costs resulting from contractor claim processing errors. Their review at three selected providers disclosed net overpayments of $149,497 for improperly reported costs due to flawed cost allocations, errors, unallowable costs and an incomplete sampling universe. Indiana had not recovered most of the audit-identified overpayments because it mistakenly believed a two-year Federal overpayment recovery limit had lapsed. OIG recommended that Indiana refund $328,151 and implement procedural refinements to reduce the likelihood of future overpayments. Indiana agreed with the recommendations.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region5/50400081.pdf
11. Review of Medicaid School-Based Administrative Costs in Minnesota From July 1, 2003, Through June 30, 2004 (A-05-05-00040)
OIG’s objective was to determine whether the State agency’s Medicaid claims for certain school districts’ school-based administrative costs were allowable in accordance with Federal and State requirements. Of the $26,852,175 ($13,426,088 Federal share) claimed for the 60 school districts reviewed, $19,479,000 ($9,739,500 Federal share) was unallowable in accordance with Federal requirements. In calculating its claims for Medicaid school-based administrative costs, the State agency used county proportional Medicaid share ratios that included children and adults instead of children only, included indirect costs that were allocable to other Federal non-Medicaid grants, and used school district cost reports that contained errors, omissions, and misstatements.
OIG recommended that the State agency (1) refund $9,739,500 to the Federal Government; (2) use proportional Medicaid share ratios that comply with Federal requirements to recalculate all State fiscal year 2004 claims for the unaudited school districts, public health agencies, and correction agencies and refund any differences; (3) require school districts, public health agencies, and correction agencies to report indirect costs in accordance with Federal requirements; and (4) develop procedures to verify the accuracy of cost report data submitted by school districts, public health agencies, and correction agencies. The State agency agreed that costs may be allocated only to the extent that they relate to Medicaid-eligible children and said that it had changed its allocation formula to be consistent with the expectations in the CMS guidance, but did not agree with our other recommendations.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region5/50500040.pdf
For the List of Excluded Individuals/Entities (LEIE), follow this link:
http://oig.hhs.gov/exclusions/index.asp
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/exclusions/index.asp
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. |
