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 Aid to Families with Dependent Children Overpayments in Maine for the Period April 1, 2001, Through March 31, 2005 (A-01-06-02504)
2. Review of Segmented Postretirement Benefit Assets at First Coast Service Options from January 1, 2002 to January 1, 2005 (A-07-06-00225)
3. Review of Postretirement Benefit Costs Claimed by First Coast Service Options for Medicare Reimbursement for Fiscal Years 2002 Through 2005 (A-07-06-00213)
4. Audit of Unobligated Balances of Funds Awarded Under the Public Health Preparedness and Response for Bioterrorism Program (A-05-05-00031)
5. Review of Place of Service Coding for Physician Services Processed by National Heritage Insurance Company During Calendar Years 2002 and 2003 (A-01-06-00502)
6. Safeguards Over Controlled Substances at Lawton Indian Hospital (A-06-06-00035)
7. OIG added a New Section to Their Website on State False Claims Act Reviews
1. Review of Aid to Families with Dependent Children Overpayments in Maine for the Period April 1, 2001, Through March 31, 2005 (A-01-06-02504)
OIG’s objective was to determine whether Maine reimbursed the Administration for Children and Families (ACF) in a timely manner for the Federal share of overpayments collected from former Aid to Families with Dependent Children (AFDC) recipients, in accordance with Federal requirements. Maine did not comply with Federal requirements for reimbursing the Federal share of collected AFDC overpayments. Maine collected $786,038 ($497,719 Federal share) from April 2001 through March 2005. However, Maine did not return the Federal share of the recovered overpayments to ACF.
OIG recommended that Maine reimburse ACF $497,719 for the Federal share of collected AFDC overpayments, follow procedures for identifying and reimbursing the Federal share of overpayments collected from former AFDC recipients, and implement procedures to ensure that its new computer system accurately segregates AFDC overpayment collections from TANF overpayment collections. Maine agreed with our findings and recommendations. Maine also agreed to reimburse an additional $171,803, the Federal share of AFDC overpayments collected since our audit ended.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region1/10602504.pdf
2. Review of Segmented Postretirement Benefit Assets at First Coast Service Options from January 1, 2002 to January 1, 2005 (A-07-06-00225)
The objective of OIG’s review was to determine whether First Coast Service Option (FCSO) properly identified and updated the Medicare segment's portion of post retirement benefit (PRB) assets from January 1, 2002 to January 1, 2005. OIG found that FCSO did not properly update the Medicare segment’s PRB assets from January 1, 2002 to January 1, 2005. As a result, Florida understated segment assets as of January 1, 2005 by $13,018. The understatement resulted from the approach used in allocating contributions and prepayment credits to the Medicare segment. OIG recommended that FCSO increase the Medicare segment PRB assets by $13,018 as of January 1, 2005.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region7/70600225.pdf
3. Review of Postretirement Benefit Costs Claimed by First Coast Service Options for Medicare Reimbursement for Fiscal Years 2002 Through 2005 (A-07-06-00213)
The objective of OIG’s review was to determine the allowability of the post retirement benefit (PRB) costs First Coast Service Options (FCSO) claimed for Medicare reimbursement on an accrual basis for fiscal years (FYs) 2002 through 2005. FCSO did not claim all accrued PRB costs that were allowable for Medicare reimbursement for FYs 2002 through 2005. During this period, the allowable accrued PRB costs were $8,894,080. However, FCSO claimed accrued PRB costs of $8,630,152 for Medicare reimbursement. FCSO therefore underclaimed $263,928 of allowable PRB costs during this period because it did not claim PRB costs in accordance with its Medicare contract.
OIG recommended that FCSO revise its Final Administrative Cost Proposals (FACPs) to claim allowable accrued PRB costs of $263,928 for FYs 2002 through 2005. OIG also recommended that FCSO claim future PRB costs in accordance with the Medicare contract. FCSO agreed with OIG’s recommendations and stated that it would revise its FACPs for FYs 2002 through 2005.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region7/70600213.pdf
4. Audit of Unobligated Balances of Funds Awarded Under the Public Health Preparedness and Response for Bioterrorism Program (A-05-05-00031)
OIG’s objectives were to determine how much funding remained unobligated at the close of the Bioterrorism Program and what factors contributed to the unobligated balances. At the close of the Bioterrorism Program, unobligated balances totaled more than $157 million for the 52 awardees that submitted financial status reports for the last budget period. This amount represented 15.8 percent of the approximately $996 million awarded for the last budget period. Although CDC had methods in place to monitor the obligation and expenditure of funds, many awardees did not fully execute their expenditure plans or submit timely financial status reports. Thus, CDC did not always receive the information needed to encourage the expenditure of funds and to minimize unobligated balances. CDC officials did not offset (reduce) new-year awards by the amount of unobligated funds carried over from the prior budget year.
Under its new program, which began August 31, 2005, CDC has strengthened its guidance and established additional controls. CDC also reports that it has obtained departmental approval to use carryover funds from the prior budget year to offset the amount of funding approved for the new budget period.
OIG recommended that CDC, in managing awards under its new program: (1) ensure that awardees submit financial status reports in a timely manner, (2) follow new program guidance to better manage grant funds among eligible entities and preparedness priorities, and (3) when appropriate, offset new-year awards by the amount of unobligated funds carried over from the prior budget year to better manage large unobligated balances and meet program goals. CDC concurred with OIG’s recommendations and stated that it had taken a number of actions that had helped to significantly reduce unobligated balances.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region5/50500031.pdf
5. Review of Place of Service Coding for Physician Services Processed by National Heritage Insurance Company During Calendar Years 2002 and 2003 (A-01-06-00502)
The objective of OIG’s audit was to determine whether physicians properly coded the place of service on claims submitted to and paid by National Heritage Insurance Company (NHIC). Physicians did not always properly code the place of service on claims submitted to and paid by NHIC. Specifically, physicians incorrectly coded the place of service on 81 of the 100 sampled claims by using the office place of service code even though they performed the services in an outpatient hospital or an ambulatory surgical center. OIG recommended that NHIC: recover the $5,423 in overpayments for sampled services, review the additional 122,054 services estimated at $4,249,190 that were potentially billed with an incorrect place of service code and work with the physicians who provided the service to recover the overpayments, strengthen the education process, and work with the payment safeguard contractor to develop a data match that will identify high-risk physician services. NHIC generally agreed.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region1/10600502.pdf
6. Safeguards Over Controlled Substances at Lawton Indian Hospital (A-06-06-00035)
OIG objective was to determine whether Lawton Indian Hospital (Lawton) complied with applicable requirements to secure and account for its Schedule II substances. Schedule II controlled substances are certain addictive drugs, the possession and use of which are regulated under the Controlled Substances Act (the Act) of 1970. Schedule II substances have the highest potential for abuse among controlled substances with an accepted medical use.
Lawton did not always comply with applicable requirements to secure and account for its Schedule II substances. Lawton did not appropriately secure or have adequate internal controls over its Schedule II substances at all locations. Lawton also did not appropriately account for its Schedule II substances at all locations.
OIG recommended that IHS direct Lawton to enforce the following security and internal controls: (1) at the main pharmacy, (a) store Schedule II substances in a locked safe during pharmacy hours, (b) consider monitoring Schedule II substances with an alarm system after pharmacy hours, and (c) separate key duties and responsibilities related to Schedule II substances among pharmacists; and (2) at the emergency room's automated dispensing unit, ensure that medical staff do not share identification codes and passwords.
OIG further recommended that IHS direct Lawton to enforce the following accountability controls: (1) at the dental clinic, perform random checks of controlled-drug inventories against medical records each month to ensure that Schedule II substances are administered to patients (2) at the main pharmacy, continue to submit monthly Schedule II inventory reports to the area pharmacy officer and (3) at the automated dispensing units in the emergency room and surgical ward, ensure that the disposal of wasted Schedule II substances is appropriately documented.
IHS concurred with OIG’s findings and recommendations and stated that Lawton had implemented, or was currently implementing, all recommended corrective actions.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region6/60600035.pdf
7. OIG added a New Section to Their Website on State False Claims Act Reviews
As enacted by section 6031 of the Deficit Reduction Act of 2005, section 1909 of the Social Security Act (Act) provides a financial incentive for States to enact false claims acts that establish liability to the State for the submission of false or fraudulent claims to the State's Medicaid program. If a State false claims act is determined to meet certain enumerated requirements, the State is entitled to an increase of 10 percentage points in its share of any amounts recovered under a State action brought under such a law.
On August 21, 2006, OIG published a notice in the Federal Register (71 FR 48552 PDF) that sets forth OIG's guidelines for reviewing State false claims acts. The guidelines invited States to request OIG's review of State laws to determine if the laws meet the requirements of section 1909(b) of the Act.
So far, OIG has reviewed State laws from California, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, Nevada, Tennessee, and Texas.
For more background information, and links to specific State reviews, go here:
http://oig.hhs.gov/fraud/falseclaimsact.html
Send Page To a Friend
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. |
