This OIG Update is also accessible from the F&D website, by visiting www.fdcpa.com/oig.updates.htm
In this issue:
1. South Carolina Medicaid Durable Medical Equipment Provider Enrollment Practices From March 21, 1995, Through June 30, 2005 (A-04-05-04010)
2. Review of Medicare Payments to Partners Home Care for Home Health Services Preceded by a Hospital Discharge (A-01-07-00503)
3. Review of Colorado's Undistributable Child Support Collections for the Period October 1, 1998, Through September 30, 2005 (A-07-07-04106)
4. Final Semiannual OIG Report to Congress for Fiscal Year 2007: OIG Reports Record $43 Billion in Savings and Recoveries
1. South Carolina Medicaid Durable Medical Equipment Provider Enrollment Practices From March 21, 1995, Through June 30, 2005 (A-04-05-04010)
The OIG’s objective was to determine whether the State agency allowed durable medical equipment (DME) suppliers to remain in the Medicaid program after their Medicare supplier numbers had been revoked. The State agency took no action against eight suppliers who violated Federal standards and had their Medicare numbers revoked. Of the eight suppliers that the OIG identified, the State agency paid $2,084,390 (Federal share $1,459,073) to four suppliers after their Medicare supplier numbers were revoked. The other four suppliers had not billed for any DME, even though they maintained active Medicaid supplier numbers.
The OIG recommended the State agency revise the DME enrollment and renewal process to include verifying the validity of an applicant’s Medicare DME supplier number and consider suspending or terminating Medicaid DME suppliers who have had their Medicare supplier numbers revoked. The State said that it would take the OIG’s findings and recommendations under advisement.
To view the full report, click here: http://www.oig.hhs.gov/oas/reports/region4/40504010.pdf
2. Review of Medicare Payments to Partners Home Care for Home Health Services Preceded by a Hospital Discharge (A-01-07-00503)
The OIG’s objective was to determine whether Partners Home Care (the agency) complied with Medicare requirements in billing for fiscal year 2004 and 2005 services for beneficiaries who had been discharged from an acute care hospital in the preceding 14 days. The agency improperly coded 231 of these claims as if the beneficiary had not had an acute care stay in the preceding 14 days. The Centers for Medicare & Medicaid Services prepayment edit corrected 155 of the 231 claims. During the OIG’s review, the agency corrected 28 of these claims totaling $13,451. The 48 remaining unadjusted claims represented overpayments of $16,443.
The OIG recommended that the agency ensure that its adjustment for the $13,451 in overpayments for the 28 claims was processed by the regional home health intermediary, return the $16,443 in overpayments associated with the remaining 48 unadjusted claims to the regional home health intermediary, and further educate its staff regarding the importance of identifying all facilities that had discharged the beneficiary within 14 days of the home health episode and determining which of these facilities were acute care (including long term care) hospitals. The agency generally agreed with the OIG’s findings but did not accept responsibility for the overpayments.
To view the full report, click here: http://www.oig.hhs.gov/oas/reports/region10/10700503.pdf
3. Review of Colorado's Undistributable Child Support Collections for the Period October 1, 1998, Through September 30, 2005 (A-07-07-04106)
The OIG’s objective was to determine whether the State agency appropriately recognized and reported program income for undistributable child support collections and interest earned on child support collections. The State agency did not recognize and report program income for undistributable child support collections because the State agency did not follow its own policies and procedures. As a result, for the period October 1, 1998, through September 30, 2005, the State agency did not recognize and report program income totaling an estimated $8,336 ($5,502 Federal share). In addition, two county offices either transferred or held $129,807 of undistributable child support collections, which the State agency claimed were not Title IV-D.
The OIG recommended that the State agency (1) report $8,336 ($5,502 Federal share) of Title IV-D program income after it transfers these collections to the State’s abandoned collections account, or revise its quarterly Federal financial reports (Form OCSE-34A) to correct these transactions; (2) work with the Office of Child Support Enforcement (OCSE) to negotiate the Federal share of the $129,807 in undistributable child support collections that may be attributable to Title IV-D and report the negotiated amount (if any) on the Form OCSE-396A; (3) work with OCSE to review undistributable child support collections for the remaining county offices and determine whether they have appropriately declared, transferred, and reported any remaining collections as program income; and (4) strengthen enforcement of, and training in, policies and procedures to ensure that undistributable child support collections are recognized and properly reported as program income.
The State agency disagreed with most of the OIG’s findings and recommendations. After reviewing the State agency’s comments, the OIG adjusted their findings and recommendations.
To view the full report, click here: http://www.oig.hhs.gov/oas/reports/region7/70704106.pdf
4. Final Semiannual OIG Report to Congress for Fiscal Year 2007: OIG Reports Record $43 Billion in Savings and Recoveries
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Semiannual Report to Congress reported total fiscal year (FY) 2007 savings and expected recoveries of $43 billion; $5 billion more than last year and more than double the savings and recoveries of just five years ago.
OIG’s FY 2007 $43.08 billion in savings encompasses $39 billion in implemented recommendations and other actions to put funds to better use; $1.9 billion in audit receivables, up from $789 million in FY 2006; and $2.18 billion in investigative receivables, an increase of $578 million from FY 2006.
“We will build on the work summarized in this report and continue to concentrate resources where challenges are greatest and benefits most advantageous to taxpayers and beneficiaries,” said Inspector General Daniel R. Levinson. “Such challenges include continued attention to Medicare Part D; Medicare, Medicaid, and SCHIP payment integrity; Medicaid administration; quality of care; public health emergency preparedness and response; food, drug, and medical device safety; grants management; information technology systems and infrastructure; and ethics program oversight and enforcement.”
To view the full press release, click here: http://www.oig.hhs.gov/publications/docs/press/2007/SemiannualRelfall2007E.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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