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 Associated Hospital Service Payments to Long-Term Care Hospitals in Massachusetts From January 1, 2003, Through April 30, 2004 (A-01-06-00506)
2. Review of Undistributable Child Support Collections in Massachusetts From October 1, 1998, Through September 30, 2005 (A-01-06-02500)
3. Prescription Drug Plan Sponsors' Compliance Plans (OEI-03-06-00100)
4. Review of Additional Reimbursement for Distinct-Part Nursing Facilities of Public Hospitals in California (A-09-05-00050)
5. Review of Nevada's Medicaid School-Based Administrative Expenditures for Calendar Years 2003 and 2004 (A-09-05-00054)
1. Review of Associated Hospital Service Payments to Long-Term Care Hospitals in Massachusetts From January 1, 2003, Through April 30, 2004 (A-01-06-00506)
The objective of OIG’s review was to determine whether Associated Hospital Service (the Intermediary) paid eight Massachusetts long-term care hospitals' (LTCH) claims in accordance with Medicare requirements when beneficiaries had used all of their regular covered benefit days. The Intermediary made full diagnosis-related group payments for (1) claims that should have been reduced to a short-stay outlier payment and (2) claims that should have been reduced by the beneficiaries' coinsurance amounts for lifetime reserve days. The Intermediary made overpayments totaling $936,418 for 83 claims to 8 LTCHs for services provided from January 1, 2003, through April 30, 2004, because the Intermediary did not ensure that LTCHs' claims contained the appropriate coverage status codes. OIG recommended that the Intermediary recover the overpayments made to 8 LTCHs for 83 claims totaling $936,418. The Intermediary generally agreed with our recommendation.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region1/10600506.pdf
2. Review of Undistributable Child Support Collections in Massachusetts From October 1, 1998, Through September 30, 2005 (A-01-06-02500)
OIG’s objectives were to determine whether the State agency appropriately reported program income for undistributable child support collections and interest earned on program funds.
For the period October 1, 1998, through September 30, 2005, the State agency did not report program income totaling $1.9 million ($1.3 million Federal share) for child support collections that qualified as abandoned property. Pursuant to Federal requirements and Massachusetts law, the State agency should have declared these collections abandoned and reported them as undistributable and program income. This deficiency occurred because the State agency did not have adequate procedures to identify and report collections that met the State's abandoned property requirements. The regional Office of Child Support Enforcement (OCSE) audit office will review the acceptability of the State agency's calculations of unreported interest.
OIG recommended that the State agency: (1) report child support collections totaling $1.9 million ($1.3 million Federal share) as abandoned and undistributable on Federal Form OCSE-34A, "Child Support Enforcement Program Quarterly Report of Collections," and report this amount as program income on the next quarterly Federal Form OCSE 396-A, "Child Support Enforcement Program Financial Report" and (2) revise its procedures to ensure that undistributable child support collections meeting the State's abandoned property requirements are reported as undistributable and program income on the quarterly Federal financial reports. The State agency generally agreed with OIG’s recommendations.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region1/10602500.pdf
3. Prescription Drug Plan Sponsors' Compliance Plans (OEI-03-06-00100)
Prescription drug plan (PDP) sponsors are required to have compliance plans in place that address eight elements outlined in Federal regulation 42 CFR § 423.504(b)(4)(vi). CMS guidance documents contain 17 requirements related to the eight elements. OIG found that while all sponsors had compliance plans, 72 of 79 compliance plans did not address one or more of CMS's 17 requirements.
One of the elements outlined in the regulation is the development of a fraud and abuse plan. OIG found that all compliance plans addressed this element in some way, yet only 15 of 79 compliance plans addressed all 11 recommendations regarding fraud detection, correction, and prevention that we included in our review. OIG recommends that CMS ensure that PDP sponsors' compliance plans address all requirements presented in its manual chapter regarding the eight elements set forth in regulation. CMS concurred with OIG's recommendation.
To access the full article, click here: http://oig.hhs.gov/oei/reports/oei-03-06-00100.pdf
4. Review of Additional Reimbursement for Distinct-Part Nursing Facilities of Public Hospitals in California (A-09-05-00050)
OIG’s objectives were to determine, for the selected facilities, whether the State agency (1) properly established eligibility for additional reimbursement and (2) claimed additional reimbursement amounts in accordance with State and Federal requirements.
The State agency properly established eligibility for additional reimbursement for the selected facilities. However, the State agency did not claim additional reimbursement amounts for two facilities in accordance with State and Federal requirements. The errors occurred because the State agency did not provide adequate instructions to the facilities to properly calculate the certified public expenditures used to support additional reimbursement amounts. Also, the State agency did not have adequate monitoring procedures to ensure that the facilities properly calculated their reported Medicaid days and expenditures. The improper calculations resulted in an overpayment of $3,609,267 (Federal share).
OIG recommended that the State agency: (1) refund $3,609,267 to the Federal Government, (2) review additional reimbursement amounts paid to the selected facilities subsequent to OIG’s audit period and refund any overpayments, (3) provide adequate instructions to all facilities to ensure that the certified public expenditures used to support additional reimbursement amounts are properly calculated, and (4) strengthen monitoring procedures to ensure that all facilities' reported Medicaid days and expenditures are properly calculated. The State agency disagreed with OIG’s finding and recommended disallowance related to the overstatement of one facility's estimated quarterly costs. However, it agreed with the remaining findings and recommendations.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region9/90500050.pdf
5. Review of Nevada's Medicaid School-Based Administrative Expenditures for Calendar Years 2003 and 2004 (A-09-05-00054)
OIG’s initial objective was to determine whether the State agency's claims for Medicaid school-based administrative expenditures were allowable and supported. Because of information that OIG discovered while reconciling these expenditures to supporting documentation, OIG added another objective: to determine whether the State agency adequately safeguarded confidential health data that it shared with its consultant, MAXIMUS, Inc. (MAXIMUS).
For calendar years 2003 and 2004, the State agency claimed $5,793,236 (Federal share) for Medicaid school-based administrative expenditures that were not allowable. In addition, the State agency claimed $775,180 (Federal share) for Medicaid school-based administrative expenditures for the summer quarter of 2004. Without a time study for the summer quarter of 2004, OIG is unable to express an opinion on the $775,180 claimed. Finally, the State agency allowed confidential Medicaid beneficiary health data to be released to MAXIMUS without written assurance that the information would be adequately safeguarded.
OIG recommended that the State agency: (1) refund $5,793,236 to the Federal Government, (2) review claims for Medicaid school-based administrative expenditures after OIG’s audit period and refund the Federal share of any unallowable costs, (3) strengthen its policies and procedures to ensure that it claims Federal funds only for Medicaid school-based administrative expenditures that are allowable and supported, (4) require the school district to conduct time studies during summer quarters when employees perform Medicaid school-based administrative activities and work with the Centers for Medicare & Medicaid Services to determine the allowability of $775,180, and (5) ensure that confidential health data are safeguarded pursuant to Federal law and regulations. The State agency generally agreed with OIG’s recommendations and stated that it was actively engaged in implementing all of them.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region9/90500054.htm
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. |
