Feeley & Driscoll's OIG Update - September 15, 2007

To Our Valued Clients and Friends,

The Department of Health and Human Services Office of the Inspector General (HHS-OIG) was established by Congress in 1976 to identify and eliminate fraud, abuse, and waste in HHS programs and to promote efficiency and economy in departmental operations. The OIG is responsible for conducting audits, evaluations, and both criminal and civil investigations for all HHS agencies. These functions are performed by the OIG's Office of Audit Services (OAS).

Feeley & Driscoll's OIG Update is a compilation of the latest and greatest additions to the OIG website

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.

In This Issue:

1. Review of Quality Improvement Organization in Rhode Island (A-01-06-00507)
2. Review of Excessive Payments for Outpatient Services Processed by Chisholm Administrative Services in 2005 (A-06-07-00058)

1. Review of Quality Improvement Organization in Rhode Island (A-01-06-00507)

The Senate Finance Committee requested that OIG assess the fiscal integrity of the Medicare Quality Improvement Organizations (QIO) with respect to six specified fiscal integrity areas. Of the $3.7 million of costs reviewed related to the six areas, the Rhode Island QIO, Rhode Island Quality Partners, provided adequate documentation to support the costs claimed.

Accordingly, this report contains no recommendations.

To view the full report, click here: http://www.oig.hhs.gov/oas/reports/region1/10600507.pdf

2. Review of Excessive Payments for Outpatient Services Processed by Chisholm Administrative Services in 2005 (A-06-07-00058)

The OIG’s objective was to determine whether the high-dollar Medicare payment that Chisholm Administrative Services (Chisholm) made to a provider for an outpatient service was appropriate. The high-dollar Medicare outpatient payment was not appropriate. For calendar year 2005, Chisholm made one payment of $50,000 or more for outpatient services. The OIG’s analysis indicated that, at the start of the OIG’s fieldwork in February 2007, the payment was incorrect, and the provider had not refunded the $57,700 overpayment. The OIG notified the provider and requested that the claim be reviewed. After reviewing the claim, the provider submitted an adjusted claim and refunded the overpayment. The Chisholm medical review team reviewed and approved the revised amount.

The OIG recommended that Chisholm review the provider’s payment history for claims under $50,000 that bill code C9205 and correct any claims found in error and use the results of this audit in its provider education activities. Chisholm agreed with the OIG’s recommendations.

To view the full report, click here: http://www.oig.hhs.gov/oas/reports/region6/60700058.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.

You have permission to forward Feeley & Driscoll’s OIG Update, in its entirety only, to your colleagues, provided this copyright notice remains part of your transmission. All other rights reserved. Feeley & Driscoll, P.C. is an accounting / business consulting firm and is not affiliated with the Office of the Inspector General, the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, or any Federal healthcare program. The OIG does not recommend or endorse particular consultants or particular consultants’ services. This information is distributed with the understanding that Feeley & Driscoll, P.C. is not rendering legal, accounting, or other professional advice or opinions on specific facts or matters, and accordingly, assumes no liability whatsoever in connection with its use. Although Feeley & Driscoll’s OIG Update includes links providing direct access to other Internet sites, Feeley & Driscoll, P.C. takes no responsibility for the content or information contained on those other sites, and does not exert any editorial or other control over those other sites.