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. Testimony Given on Allegations of Waste, Fraud and Abuse in Pharmaceutical Pricing
2. Medicare Part B Services for Nursing Home Residents: 2002 (OEI-05-06-00240)
3. Suspected Medicaid Fraud Referrals (OEI-07-04-00181)
4. Review of Pension Costs Claimed for Medicare Reimbursement by CIGNA for Fiscal Years 1991 Through 2004 (A-07-06-00209)
5. Rat-Stats 2007 Version 1 Now Available on the OIG Internet Site
1. Testimony Given on Allegations of Waste, Fraud and Abuse in Pharmaceutical Pricing
Testimony was given on 2/9 by Lewis Morris, Chief Counsel to the Inspector General, before the U.S. House Oversight and Government Reform Committee, on Allegations of Waste, Fraud and Abuse in Pharmaceutical Pricing: Financial Impacts on Federal Health Programs
To get to the testimony: http://oig.hhs.gov/testimony/docs/2007/020907tmy.pdf
2. Medicare Part B Services for Nursing Home Residents: 2002 (OEI-05-06-00240)
This memorandum report describes Medicare Part B services and allowed payments for nursing home residents not in a Medicare Part A covered stay during calendar year (CY) 2002. Previous studies by the Office of Inspector General (OIG) have determined that Medicare Part B payments for beneficiaries residing in nursing homes are particularly vulnerable to fraud and abuse. To protect the integrity of these Medicare payments, Congress required OIG to monitor potentially excessive or duplicative billing of Medicare Part B services for nursing home residents not in a Part A covered stay.
While this analysis does not establish whether CY 2002 payments are excessive or duplicative, it provides baseline data. Building on this work, OIG plans to assess more current data to help identify potential patterns and areas of questionable billing. As appropriate, OIG will review identified areas to establish the extent of excessive or duplicative payment and recommend controls to minimize or alleviate these payments.
This review found that Medicare allowed $5.3 billion for Part B services provided to 1.8 million nursing home residents who were not in a Part A covered stay in CY 2002. The $5.3 billion represents 5 percent of the total amount that Medicare allowed for all Part B services during CY 2002. Ten categories of service account for 79 percent of payments for Part B services for nursing home residents. In addition, payments varied by State for each of the top 10 categories.
To access the full article, click here: http://oig.hhs.gov/oei/reports/oei-05-06-00240.pdf
3. Suspected Medicaid Fraud Referrals (OEI-07-04-00181)
Medicaid Fraud Control Units (MFCU) reported receiving a total of 13,733 suspected fraud referrals over a 3-year period (July 2002 through June 2005), of which 29 percent came from State Medicaid agencies. Eighty-four percent of MFCUs providing information reported receiving less than half of all suspected fraud referrals from their respective State Medicaid agencies.
Overall, State Medicaid agency contributions to total MFCU-accepted referrals remained constant over a 3-year period, but individual States fluctuated widely. Fifty-nine percent of MFCUs reported accepting fewer referrals from their respective State Medicaid agency in the last year of our review compared to the average number of referrals over all 3 years. One State Medicaid agency contributed to 67 percent of the increase in MFCU-accepted referrals over the 3-year study period.
OIG recommended that CMS establish fraud referral performance standards for State Medicaid agencies. CMS concurred with OIG’s recommendation.
To access the full article, click here: http://oig.hhs.gov/oei/reports/oei-07-04-00181.pdf
4. Review of Pension Costs Claimed for Medicare Reimbursement by CIGNA for Fiscal Years 1991 Through 2004 (A-07-06-00209)
CIGNA administers Medicare Part B and Durable Medical Equipment operations under cost reimbursement contracts with the Centers for Medicare & Medicaid Services and claims reimbursement for its Medicare employees' pension costs. Regulations and the Medicare contracts provide guidance for claiming pension costs.
OIG’s objective was to determine the allowability of pension costs that CIGNA claimed for Medicare reimbursement for fiscal years (FY) 1991-2004. CIGNA claimed $3,103,925 of unallowable pension costs for FYs 1991-2004 because it did not claim pension costs in accordance with the Medicare contracts.
OIG recommended that CIGNA revise its Final Administrative Cost Proposals to reduce claimed pension costs by $3,103,925. OIG also recommended that CIGNA claim future pension costs in accordance with the Medicare contracts. CIGNA disagreed in part with OIG’s original recommendation to reduce claimed pension costs by $3,425,240 but agreed that its claimed pension costs should be reduced. CIGNA also agreed to claim future pension costs in accordance with the Medicare contracts. After reviewing CIGNA's comments, OIG revised their calculations and the related recommendation to reduce claimed pension costs.
To access the full article, click here: http://oig.hhs.gov/oas/reports/region7/70600209.pdf
5. Rat-Stats 2007 Version 1 Now Available on the OIG Internet Site
The Latest Version of the OIG's Statistical Software, Rat-Stats 2007 version 1 is now available on the OIG Internet site.
Rat-Stats 2007 replaces both the Windows Rat-Stats version 1 and DOS Rat-Stats.
Rat-Stats 2007 includes all the statistical modules included in DOS Rat-Stats. Rat-Stats 2007 does not require files to be written to the root directory, as Windows RAT-STATS version 1 did, thus avoiding the security hazard of writing to the root directory.
To get to the new Rat-Stats program and manuals, go here: http://oig.hhs.gov/organization/OAS/ratstat.html
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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. |
