A biweekly publication from the Healthcare Group at Feeley & Driscoll, P.C.
Please visit us at OIG’s 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.
1. Review of Quality Improvement Organization in Missouri (A-07-06-01036)
2. Audit of Unobligated Balances of Funds Awarded Under the Bioterrorism Hospital Preparedness Program," (A-05-06-00024)
3. Proposed Rule Withdrawal Notice: Clarification of Terms and Applications of Program Exclusion Authority for Submitting Claims Containing Excessive Charges (42 CFR Part 1001)
4. Addendum to “Hospital Discounts to Patients Who Cannot Afford to Pay Their Hospital Bills.”
5. Review of Vendor Rebates Paid to Hospitals - Kaiser Foundation Hospitals and Health Plans, Inc., Oakland, California (A-05-07-00051)
6. OIG Advisory Opinion: Retail Pharmacy Participation in Medicare Part D Prescription Drug Plans in 2006 (OEI-05-06-00320)
1. Review of Quality Improvement Organization in Missouri (A-07-06-01036)
The Senate Finance Committee requested that the Office of Inspector General assess the fiscal integrity of Medicare Quality Improvement Organizations (QIO) with respect to six specified subject areas. In Missouri, Primaris was the QIO for the period February 1, 2003, through January 31, 2006.
The audit objective was to review the six fiscal integrity areas requested by the Senate Finance Committee.
Of the $4.8 million of costs reviewed related to the six fiscal integrity areas requested by the Senate Finance Committee, Primaris provided adequate documentation to support the costs claimed. Accordingly, this report contains no recommendations.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region7/70601036.pdf
2. Audit of Unobligated Balances of Funds Awarded Under the Bioterrorism Hospital Preparedness Program," (A-05-06-00024)
The audit objective was to determine whether the percentage of unobligated Bioterrorism Hospital Preparedness Program (Bioterrorism Program) balances decreased from program year 2002 to program year 2004.
The percentage of unobligated Bioterrorism Program balances decreased from program year 2002 to program year 2004. Based on OIG’s analysis of available financial status reports submitted by awardees, unobligated balances declined from 15.7 percent of the awarded funds for program year 2002 to 5.1 percent of the awarded funds for program year 2004. Because program year 2004 had not expired for six grantees as of the completion of the audit (January 9, 2007), these grantees could further reduce their unobligated balances. The Health Resources and Services Administration (HRSA) has contributed to the reduced percentage of unobligated balances by strengthening its oversight, training, and onsite monitoring of awardees and by using available enforcement actions.
OIG recommended that HRSA continue to use available monitoring tools and enforcement actions to reduce unobligated funds until such time as the Assistant Secretary for Preparedness and Response assumes responsibility for the Bioterrorism Program. HRSA concurred with the recommendation.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region5/50600024.pdf
3. Proposed Rule Withdrawal Notice: Clarification of Terms and Applications of Program Exclusion Authority for Submitting Claims Containing Excessive Charges (42 CFR Part 1001)
On September 15, 2003, the OIG published a notice of proposed rulemaking (68 FR 53939) soliciting public comments regarding further guidance on OIG’s exclusion authority under section 1128(b)(6)(A) of the Social Security Act and 42 CFR 1001.701 of the OIG’s regulations. Having considered the public comments and for the reasons explained below, the OIG is not promulgating a final rule. The notice of proposed rulemaking was published on September 15, 2003 at 68 FR 53939.
To view the full article, click here: http://www.oig.hhs.gov/authorities/docs/FR%20Notice%20Withdrawal%20of%20Substantially%20in%20Excess%20Rule.pdf
4. Addendum to “Hospital Discounts to Patients Who Cannot Afford to Pay Their Hospital Bills.”
In light of the proposed rule withdrawl notice mentioned above, the OIG posted an addendum to its 02/02/2004 document titled “Hospital Discounts to Patients Who Cannot Afford to Pay their Hospital Bills.” This document discussed the OIG’s views on discounts offered to patients who cannot afford to pay their hospital bills under the Federal anti-kickback statute at section 1128B(b) of the Social Security Act (“Act”), 42 U.S.C. § 1320a-7b(b). The OIG’s position continues to be current guidance, but this addendum clarifies several OIG policies as announced in the 02/02/2004 document.
To view the full article, click here: http://www.oig.hhs.gov/fraud/docs/alertsandbulletins/2007/revised%20addendum%20to%20uninsured%20guidance%20_4_%20_2_%20_2_.pdf
5. Review of Vendor Rebates Paid to Hospitals - Kaiser Foundation Hospitals and Health Plans, Inc., Oakland, California (A-05-07-00051)
The objective of our review was to determine whether Kaiser Foundation Hospitals and Health Plans, Inc. (the provider) reduced costs reported on its fiscal year 2003 Medicare cost report by the $35,438 vendor rebate it received. The provider did not reduce costs reported on its fiscal year 2003 Medicare cost report by the $35,438 rebate, contrary to Federal regulations and CMS guidance.
The OIG recommended that the provider (1) revise and resubmit its 2003 Medicare cost report, if not already settled, to properly reflect the $35,438 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 the OIG’s recommendations.
To view the full article, click here: http://www.oig.hhs.gov/oas/reports/region5/50700051.pdf
6. OIG Advisory Opinion: Retail Pharmacy Participation in Medicare Part D Prescription Drug Plans in 2006 (OEI-05-06-00320)
CMS requires stand-alone prescription drug plans to contract with a sufficient number of retail pharmacies to ensure that beneficiaries have access to retail pharmacies dispensing Part D-covered drugs. This report determines (1) the extent to which retail pharmacies participate in Medicare Part D stand-alone prescription drug plans (PDPs), and (2) how many Medicare Part D stand-alone PDPs are offered by participating retail pharmacies.
The OIG found that nearly all retail pharmacies participate in Medicare Part D. Ninety-seven percent of retail pharmacies participate in at least one PDP. Furthermore, retail pharmacies in metropolitan and nonmetropolitan counties participate at similarly high rates. The OIG also found that 70 percent of participating retail pharmacies offer beneficiaries the choice of all available PDPs in their region. Retail pharmacies in metropolitan and nonmetropolitan counties offer beneficiaries the choice of all available PDPs at similarly high rates. Almost all independent and chain retail pharmacies offer beneficiaries the choice of at least half of the available PDPs.
The OIG’s findings indicate that beneficiaries' access to retail pharmacies dispensing Part D-covered drugs does not appear to be limited by retail pharmacies' participation in PDPs. Although having fewer retail pharmacies located in an area may limit beneficiary access to retail pharmacies, the OIG’s findings suggest that Part D does not further limit beneficiary access. In response to the OIG’s draft report, CMS stated that it was pleased with the OIG’s findings that beneficiary access to retail pharmacies dispensing Part D-covered drugs does not appear to be limited by retail pharmacies' participation in PDP networks. Additionally, CMS reiterated its commitment to ensuring that Part D beneficiaries have access to retail pharmacies.
To view the full article, click here: http://www.oig.hhs.gov/oei/reports/oei-05-06-00320.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 they 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.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.
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