1.   Review of Nebraska Medicare Part D Contributions to the Centers for Medicare & Medicaid Services for “Full-Duals” (A-07-07-01040)

2. State Medicaid Agency Referrals to the Office of Inspector General Exclusions Program  (OEI-01-06-00301) 

3. Deficiency History and Recertification of Medicare Home Health Agencies  (OEI-09-06-00040) 

4. Review of Expenses and Revenues Presented in Congressional Testimony by East Jefferson General Hospital (A-06-08-00009)

5. Follow-Up Audit of the Medicaid Drug Rebate Program In Wyoming," (A-07-08-03106)

1. Review of Nebraska Medicare Part D Contributions to the Centers for Medicare & Medicaid Services for “Full-Duals” (A-07-07-01040)

From January through October 2006, the Nebraska Department of Health and Human Services (Nebraska) did not always make a corresponding contribution payment to the Centers for Medicare & Medicaid Services (CMS) on behalf of Medicaid recipients who were also eligible for Medicare (full-duals).  Federal regulations require States to make contribution payments to CMS in order to defray a portion of the costs of the Medicare Part D program.

The OIG’s review found that for the 300 statistically sampled beneficiary-months, Nebraska (1) was not required to make contributions to CMS because the beneficiaries were not actually full-duals in the sampled months or were not identified in the State’s Medicaid eligibility records or (2) made subsequent retroactive contributions to CMS.  The OIG’s report made no recommendations.

Click here to view the full article: http://www.oig.hhs.gov/oas/reports/region7/70701040.pdf

2. State Medicaid Agency Referrals to the Office of Inspector General Exclusions Program  (OEI-01-06-00301) 

This memorandum report determines the extent to which final actions taken by State Medicaid Agencies in 2004 and 2005 were received by OIG.  Individuals and entities (providers) who are suspended or excluded from participation, or otherwise sanctioned for reasons bearing on professional competence, professional performance, or financial integrity (final actions) by State Medicaid agencies, are subject to a permissive exclusion by OIG.  When State Medicaid agencies take final actions against providers, they are required to promptly report the providers to OIG. 

OIG found that about two-thirds of providers with final actions imposed by State Medicaid Agencies in 2004 and 2005 were not found in the exclusions database.  OIG also found that match rates varied widely across States.  Eleven States had a match rate of less than 25 percent, while nine States had a match rate greater than 75 percent.  In addition, officials from State Medicaid agencies conveyed uncertainty about the types of information to send with referrals, the types of final actions to refer to OIG, and the outcome of the referrals that they make. 

Further, despite the barriers, State Medicaid agencies rate recent outreach from OIG as helpful and would welcome more information about exclusions processes.  OIG’s results show that opportunities exist for both OIG and State Medicaid agencies to increase the number of referrals of providers with final actions. 

Click here to view the full article: http://oig.hhs.gov/oei/reports/oei-01-06-00301.pdf

3. Deficiency History and Recertification of Medicare Home Health Agencies  (OEI-09-06-00040) 

The OIG found that 15 percent of home health agencies (HHA) repeated the same deficiency citation on three consecutive surveys (referred to as cyclically deficient HHAs).  Cyclically deficient HHAs most frequently repeated deficiency citations related to patient plans of care.  These HHAs received twice as many deficiency citations on past surveys compared to HHAs that did not repeat citations. 

Among cyclically deficient HHAs, most are located in six States and tend to be concentrated in highly populated areas.  Additionally, CMS's oversight of HHAs could be improved.  Currently, CMS does not use all available deficiency history information in its oversight of HHAs.  The OIG found that deficiency history beyond the most recent survey can be an important indicator of performance on the next survey and can improve CMS's identification of at-risk HHAs.  For HHAs with deficiency citations, termination from the Medicare program remains the only Federal sanction.  Based on the findings of this report,

OIG recommends that CMS use existing survey data to identify patterns of deficiency citations and at-risk HHAs and implement intermediate sanctions as directed by the Omnibus Budget Reconciliation Act of 1987.  CMS generally concurred with the OIG’s recommendations and indicated that, during the last several years, it has implemented improvements to the oversight of HHAs, many of which address the issue of repeated deficiencies.  The OIG responded to CMS's concerns about using existing survey data to identify at-risk HHAs. 

To view the full report, click here: http://www.oig.hhs.gov/oei/reports/oei-09-06-00040.pdf

4. Review of Expenses and Revenues Presented in Congressional Testimony by East Jefferson General Hospital (A-06-08-00009)

East Jefferson General Hospital’s (the hospital) expenses for the first 5 months of 2005 and the first 5 months of 2007 presented in its congressional testimony were generally accurate and supported by its financial records.  However, the hospital’s revenue as described in the testimony for the first 5 months of 2007 did not include $4 million in a Medicare Wage Stabilization grant it received during this period.  The Louisiana Hospital Association removed this amount when compiling the testimony data and referenced the grant amount in an explanatory note. 

The OIG conducted this review at the request of the House Committee on Energy and Commerce, before which the hospital testified at a hearing on August 1, 2007.

The hospital agreed with the results of the OIG’s review.  This was an informational report, and the OIG had no recommendations.

Click here to view the full article: http://www.oig.hhs.gov/oas/reports/region6/60800009.pdf

5. Follow-Up Audit of the Medicaid Drug Rebate Program In Wyoming," (A-07-08-03106)

In a follow-up audit of Wyoming’s Medicaid drug rebate program, the OIG found that the State had implemented the recommendations from the OIG prior audit relating to the maintenance of an adequate subsidiary accounts receivable system and had developed policies and procedures for the tracking, billing and accounting for $0 unit rebate amounts.  Manufacturers may make their outpatient drugs eligible for Federal Medicaid funding by entering into a rebate agreement with the Centers for Medicare & Medicaid Services (CMS) and paying quarterly rebates to the States.

However, the State continued to inaccurately report drug rebate activity on the Form CMS-64.9R.  Additionally, the State did not implement recommendations related to various accounting and dispute resolution procedures.  Finally, the State did not establish controls over and accountability for collecting rebates on single-source drugs administered by physicians.

The OIG recommended that the State work with its contractor and CMS to determine how to correct the inaccuracies that were reported on the Form CMS-64.9R.  The OIG also continued to recommend that the State improve its accounting and dispute resolution procedures and develop a system for the collection of drug rebates on single-source drugs administered by physicians.

In written comments on the OIG’s draft report, the State agency generally concurred with the OIG’s findings and recommendations and outlined its proposed corrective actions.

Click here to view the full article: http://www.oig.hhs.gov/oas/reports/region7/70803106.pdf