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 Medicaid Credit Balances at Baystate Mary Lane Hospital for the Period Ending June 30, 2006 (A-01-06-00010)
2. Review of Vendor Rebates Paid to Hospitals - Staten Island University Hospital, Staten Island, New York (A-05-07-00055)
3. Review of Vendor Rebates Paid to Hospitals - Review of Vendor Rebates Paid to Hospitals - University of Iowa Hospitals and Clinics (A-05-07-00049)
4. Review of Vendor Rebates Paid to Hospitals - Review of Vendor Rebates Paid to Hospitals - Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (A-05-07-00046)
5. Encounter Data Submitted by CommunityCare Oklahoma for 2003 Monthly Capitation Payments (A-06-06-00104)
6. Review of Medicaid Reimbursement Rate for School-Based Health Services in Maryland (A-03-05-00206)
7. Review of the Management of Unobligated Funds Provided by Title II of the Ryan White Comprehensive AIDS Resources Emergency Act (A-06-04-00060)
1. Review of Medicaid Credit Balances at Baystate Mary Lane Hospital for the Period Ending June 30, 2006 (A-01-06-00010)
OIG identified 122 overpayments greater than 60 days old that Baystate Mary Lane Hospital (the Hospital) should have returned to the Medicaid program. Specifically, the Hospital did not promptly return Medicaid overpayments of $15,738 ($7,869 Federal share) to the Medicaid program in accordance with State Medicaid requirements. These errors occurred because the Hospital did not follow its internal procedures for processing and returning Medicaid overpayments. OIG recommended that the Hospital return to the Massachusetts Medicaid program overpayments totaling $15,738 ($7,869 Federal share) and continue efforts to identify and return all overpayments to Medicaid in accordance with State requirements. The Hospital agreed substantially with OIG’s observations and findings.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region1/10600010.pdf
2. Review of Vendor Rebates Paid to Hospitals - Staten Island University Hospital, Staten Island, New York (A-05-07-00055)
The objective of OIG’s review was to determine whether Staten Island Hospital (the provider) reduced costs reported on its fiscal years 2003 and 2004 Medicare cost reports by the $48,014 it received for two vendor rebates. The provider properly reduced its fiscal year 2004 Medicare cost report by $33,410 for one rebate. However, the provider did not reduce costs reported on its fiscal year 2003 cost report by the remaining $14,604 rebate, contrary to Federal regulations and Centers for Medicare and Medicaid Services guidance.
OIG recommended that the provider (1) revise and resubmit its 2003 Medicare cost report, if not already settled, to properly reflect the $14,604 rebate as a credit reducing its health care costs; and (2) consider performing a self-assessment of its internal controls to ensure that future vendor rebates are properly credited on its Medicare cost reports. The provider agreed with OIG’s recommendations.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region5/50700055.pdf
3. Review of Vendor Rebates Paid to Hospitals - Review of Vendor Rebates Paid to Hospitals - University of Iowa Hospitals and Clinics (A-05-07-00049)
The objective of OIG’s review was to determine whether University of Iowa Hospitals and Clinics (the provider) reduced costs reported on its fiscal year 2004 Medicare cost report by the $77,014 vendor rebate it received. The provider did not reduce costs reported on its fiscal year 2004 Medicare cost report by $70,056, contrary to Federal regulations and Centers for Medicare and Medicaid Services (CMS) guidance.
OIG recommended that the provider (1) revise and resubmit its 2004 Medicare cost report, if not already settled, to properly reflect the $70,056 rebate as a credit reducing its health care costs and (2) consider performing a self-assessment of its internal controls to ensure that future vendor rebates are properly credited on its Medicare cost reports. The provider agreed with OIG’s recommendations.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region5/50700049.pdf
4. Review of Vendor Rebates Paid to Hospitals - Review of Vendor Rebates Paid to Hospitals - Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (A-05-07-00046)
The objective of OIG’s review was to determine whether Penn State Milton S. Hershey Medical Center (the provider) reduced costs reported on its 2004 Medicare cost report by the $34,136 vendor rebate it received. The provider did not reduce costs reported on its fiscal year 2004 Medicare cost report by $34,136 rebate, contrary to Federal regulations and the Centers for Medicare and Medicaid Services (CMS) guidance.
OIG recommended that the provider (1) revise and resubmit its 2004 Medicare cost report, if not already settled, to properly reflect the $34,136 rebate as a credit reducing its health care costs and (2) consider performing a self-assessment of its internal controls to ensure that future vendor rebates are properly credited on its Medicare cost reports. The provider agreed with OIG’s recommendations.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region5/50700046.pdf
5. Encounter Data Submitted by CommunityCare Oklahoma for 2003 Monthly Capitation Payments (A-06-06-00104)
The objective of OIG’s review was to determine whether the encounter data the Centers for Medicare and Medicaid Services (CMS) used as the basis for the 2003 monthly capitation payments made on behalf of beneficiaries enrolled in CommunityCare’s Senior Health Plan were valid and accurate. All of the encounter data supporting inpatient claims for beneficiaries in OIG’s sample met OIG’s definition of “valid encounter data.” Furthermore, in accordance with chapter 7 of the CMS “Managed Care Manual” and the CMS “Risk Adjustment Training Manual.”
CMS appropriately used the diagnoses provided to assign risk factors to beneficiaries in OIG’s sample. However, medical records did not always substantiate the encounter data used to determine beneficiaries’ risk factors. OIG recommended that CommunityCare (1) strengthen internal controls to ensure that providers maintain medical records, (2) insert into provider contracts provisions that promote the accurate recording of encounter data, and (3) train providers to code diagnoses accurately. CommunityCare generally agreed with OIG’s findings.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region6/60600104.pdf
6. Review of Medicaid Reimbursement Rate for School-Based Health Services in Maryland (A-03-05-00206)
The audit objective was to determine whether Maryland’s claims for Medicaid reimbursement of school-based health services complied with the approved State plan and Federal requirements. Maryland did not comply with its approved State plan, which required that the State claim reimbursement for school-based health services based on cost. The State agency used a reimbursement rate of $82 per service but could not show that the rate was based on the cost of services. Because OIG could not review the data used to calculate the rate, OIG calculated a rate for each year in the audit period.
By claiming payment for services at its rate of $82, Maryland received reimbursement totaling $146,536,378 ($73,268,189 Federal share). Using the recalculated rates, OIG allowed $81,014,559 ($40,507,280 Federal share) of the $146,536,378. The $65,521,819 ($32,760,910 Federal share) difference represented an overpayment.
OIG recommended that the State agency: (1) refund $32,760,910 to the Federal Government for unallowable basic education costs included in reimbursement for school-based health services in State fiscal years (FY) 2002 through 2004, (2) determine the unallowable basic education costs included in reimbursement for State FY 2005 and make the appropriate refund, and (3) continue to work with CMS and the Maryland State Department of Education in developing more accurate school-based health service rates and make the necessary revisions to the State plan. The State agency agreed that the rate for school-based Medicaid services reflected unallowable education costs and that the rates should be reduced.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region3/30500206.pdf
7. Review of the Management of Unobligated Funds Provided by Title II of the Ryan White Comprehensive AIDS Resources Emergency Act (A-06-04-00060)
The audit objective was to determine whether the Health Resources and Services Administration (HRSA) complied with applicable requirements and used its offset authority in managing unobligated funds provided by Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
During grant years 1999–2002, HRSA did not fully comply with applicable requirements for managing unobligated Title II funds. Contrary to the CARE Act, HRSA did not recoup Title II funds from States that had not obligated at least 75 percent of their grant awards within 120 days and reallot those funds to other States in proportion to their original grants. Contrary to Department of Health and Human Services (HHS) policy, HRSA authorized States to carry over unobligated Title II funds beyond one budget period. In addition, HRSA did not use the offset authority provided by the CARE Act and HHS grants policy to manage States’ unobligated balances.
OIG recommended that HRSA (1) monitor the States’ compliance with the CARE Act requirement to obligate 75 percent of the grant award within 120 days and, for States that do not meet this requirement, recoup the unobligated portion of the 75 percent of the grant award and reallot such funds to other States in proportion to their original grants; (2) comply with the current carryover policy; (3) examine the reasons for some States’ large unobligated balances; and (4) analyze each State’s unobligated balance from the preceding grant year in light of relevant factors to determine whether the balance should be deobligated or carried over and, if carried over, determine whether the amount should be an addition to the State’s full amount of funding approved for the current grant year or an offset to the State’s current-year grant award, which would provide additional funding for other States’ unmet program needs. HRSA generally disagreed with the findings.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region6/60400060.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. |
