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 from the OIG's website, listed in approximate order of greatness rather than lateness.

A biweekly publication from the Healthcare Group at Feeley & Driscoll, P.C. This email is also accessible from the F&D website by clicking through to our OIG Updates Archive.

In this issue

1. OIG Supplemental Compliance Program Guidance for Nursing Facilities
2. Trends in Nursing Home Deficiencies and Complaints  (OEI-02-08-00140)
3. Review of Comprehensive Outpatient Rehabilitation Facility Therapy Services Provided by Ultimate Rehabilitation Agency, Inc. (A-04-05-02009)
4. Review of Minnesota’s Drug Rebate Accounts Receivable Balance Reported on the Form CMS-64 (A-05-08-00058) 
5. Review of High-Dollar Payments for Medicare Part B Claims Processed by Palmetto GBA, Railroad Benefit Contractor #882, for the Period January 1, 2004, Through December 31, 2006 (A-04-07-06026)
6. Review of Louisiana Bioterrorism Hospital Preparedness Program (A-06-07-00012)
7. Review of Profitability Analysis of New Orleans Hospitals Compared With Peer Hospitals (A-07-07-02734)
8. Review of Profitability Analysis of New Orleans Hospitals  (A-07-07-02733)
9. Review of Medicare Contractor Information Security Program Evaluations for Fiscal Year 2005 (A-18-06-02600)
10. Review of High-Dollar Payments for Medicare Part B Claims Processed by Palmetto GBA, Carrier #880, for the Period January 1, 2004, Through December 31, 2006 (A-04-07-06025)
11. Review of High Dollar Payments for Inpatient Services Processed by National Government Services in Illinois, Indiana, Kentucky, and Ohio for Calendar Years 2004 Through 2006 - Hospitals with Less Than 10 High Dollar Payments (A-05-08-00027)  

1. OIG Supplemental Compliance Program Guidance for Nursing Facilities

OIG today posts new voluntary supplemental compliance program guidance (CPG) for nursing facilities -- and a news release announcing the guidance -- to the website.

The new CPG will help nursing facilities develop compliance programs that address major Medicare and Medicaid fraud and abuse problems related to poor quality of care, billing Federal health care programs, and kickbacks.   

You can access the new guidance here:  http://oig.hhs.gov/fraud/docs/complianceguidance/nhg_fr.pdf

To access the news release, go here:  http://oig.hhs.gov/publications/docs/press/2008/nhg_press.pdf

2. Trends in Nursing Home Deficiencies and Complaints  (OEI-02-08-00140) http://www.oig.hhs.gov/oei/reports/oei-02-08-00140.pdf

This study describes the nature and extent of nursing home deficiencies and complaints in 2007 and identifies trends from 2005 to 2007.  In each of the past 3 years, over 91 percent of nursing homes surveyed were cited for deficiencies and a greater percentage of for-profit nursing homes were cited for deficiencies than not-for-profit and government nursing homes. 

During those same years, the most common deficiency categories cited were quality of care, resident assessment, and quality of life.  Additionally, 17 percent of nursing homes surveyed in 2007 were cited for actual harm or immediate jeopardy deficiencies, and 3.6 percent were cited for substandard quality-of-care deficiencies-a slight increase since 2005.  Lastly, the number of substantiated complaints decreased nearly 3 percent since 2005. 

This study is part of OIG's continuing commitment to addressing the quality of care in nursing homes.  The information provided in this memorandum report is based on an analysis of data from CMS's Online Survey and Certification Reporting System. 

3. Review of Comprehensive Outpatient Rehabilitation Facility Therapy Services Provided by Ultimate Rehabilitation Agency, Inc. (A-04-05-02009) http://www.oig.hhs.gov/oas/reports/region4/40502009.pdf

For calendar year 2003, the OIGestimated that Ultimate Rehabilitation Facility Inc. received $1.4 million for outpatient therapy services that did not meet Medicare reimbursement requirements.

4. Review of Minnesota’s Drug Rebate Accounts Receivable Balance Reported on the Form CMS-64 (A-05-08-00058) 
http://www.oig.hhs.gov/oas/reports/region5/50800058.pdf

The Minnesota Department of Human Services understated the reported accounts receivable balance by approximately $31.4 million and reported a credit balance of $10.2 million on the Form CMS-64.9R as of June 30, 2006.

5. Review of High-Dollar Payments for Medicare Part B Claims Processed by Palmetto GBA, Railroad Benefit Contractor #882, for the Period January 1, 2004, Through December 31, 2006 (A-04-07-06026)
http://www.oig.hhs.gov/oas/reports/region4/40706026.pdf

During calendar years 2004-2006, Palmetto GBA (the national Railroad Medicare Part B contractor) overpaid eight providers $111,000.  Generally, the contractor made the overpayments because the providers incorrectly billed excessive units of service.  In written comments on the OIG draft report, Palmetto stated that it had initiated recovery of the $110,905 in overpayments.

6. Review of LouisianaBioterrorismHospital Preparedness Program (A-06-07-00012)
http://www.oig.hhs.gov/oas/reports/region6/60700012.pdf

The State improperly charged the Bioterrorism Hospital Preparedness Program $54,000.  In addition, $89,000 in expenditures is being set aside for further review by the Health Resources and Services Administration.

7. Review of Profitability Analysis of New Orleans Hospitals Compared With Peer Hospitals (A-07-07-02734)
http://www.oig.hhs.gov/oas/reports/region7/70702734.pdf

 On August 1, 2007, five New Orleans hospital groups (testifying hospitals) testified before the House Committee on Energy and Commerce that they had experienced significant operating losses following Hurricane Katrina in 2005.  At the request of the committee, the OIG analyzed the testifying hospitals' profitability trends.  In this report, the OIG compared profitability trends and characteristics of the testifying hospitals with three sets of peer hospitals.

The testifying hospitals experienced profitability trends that (1) differed from those of the peer hospitals and (2) reflected both the adverse financial impact of Hurricane Katrina and subsequent financial improvements after the testifying hospitals received Business Interruption insurance payments and additional Federal funding because of their hurricane damage.  Specifically, the testifying hospitals experienced negative margins during both the fiscal year (FY) before the hurricane (FY 2004) and the FY in which the hurricane occurred (FY 2005).  For the FY after the hurricane, the testifying hospitals experienced both positive and negative margins, but the negative margins were trending upward in comparison with those of the previous year.  The margins for the peer hospitals during this time period were much more variable, though with generally less fluctuation from one fiscal year to the next.

This was an informational report, and the OIG made no recommendations.

8. Review of Profitability Analysis of New Orleans Hospitals  (A-07-07-02733) http://www.oig.hhs.gov/oas/reports/region7/70702733.pdf

On August 1, 2007, five New Orleans hospital groups (testifying hospitals) testified before the House Committee on Energy and Commerce that they had experienced significant operating losses following Hurricane Katrina in 2005.  At the request of the committee, the OIG analyzed the testifying hospitals' profitability trends.

For fiscal years (FY) 2002-2006, each of the testifying hospitals had a significantly different profitability trend.  The hospitals' cumulative results varied by type of expenditure and FY.  Cumulative patient-related care margins were positive for FYs 2002-2003 and negative for FYs 2004-2006.  Cumulative total margins were positive for FYs 2002-2003 and negative for FYs 2004-2005.  For FY 2006, the hospitals had a cumulative positive total margin and received additional funding from Business Interruption insurance payments and additional Federal funding for hurricane damage.  Cumulative Medicare program margins were positive for FY 2002 and negative for FYs 2003-2006.  Cumulative Medicaid program margins were negative for FYs 2002-2006.

This was an informational report, and the OIG made no recommendations.

9. Review of Medicare Contractor Information Security Program Evaluations for Fiscal Year 2005 (A-18-06-02600)
http://www.oig.hhs.gov/oas/reports/region1/180602600.pdf

In a review of the Centers for Medicare and Medicaid Services' (CMS) Federal Information Security Management Act (FISMA) evaluations of information security programs at Medicare fiscal intermediaries and carriers for fiscal year (FY) 2005, the OIG found that the scope and sufficiency of the evaluations adequately encompassed the eight FISMA requirements.  CMS contracted with an outside firm to provide a comprehensive program to perform testing of security, but the OIG could not determine the scope or sufficiency of the work for the data center technical assessments because the OIG could not determine the extent of the contractor's work.

Each Medicare contractor must have its information security program evaluated annually by an independent entity.  The Inspector General must submit to Congress annual reports on the results of these evaluations, as well as their scope and sufficiency.  This report fulfills that responsibility for FY 2005.

The OIG recommended that CMS review contractor documentation related to future data center technical assessments and ensure that contractor documentation complies with CMS contractual requirements.  In written comments on the OIG draft report, CMS concurred with the OIG recommendation.

CMS also provided clarifying information on technical issues that the OIG used to modify the OIG report where appropriate.

10. Review of High-Dollar Payments for Medicare Part B Claims Processed by Palmetto GBA, Carrier #880, for the Period January 1, 2004, Through December 31, 2006 (A-04-07-06025) http://www.oig.hhs.gov/oas/reports/region4/40706025.pdf

During calendar years 2004-2006, Palmetto GBA (the contractor) overpaid
16 Part B providers $34,000 for high-dollar Medicare payments ($10,000 or more).  Generally, the contractor made the overpayments because the providers incorrectly billed excessive units of service.  In written comments on the OIG draft report, Palmetto stated that it had initiated recovery of the $34,000 in overpayments.

11. Review of High Dollar Payments for Inpatient Services Processed by National Government Services in Illinois, Indiana, Kentucky, and Ohio for Calendar Years 2004 Through 2006 - Hospitals with Less Than 10 High Dollar Payments (A-05-08-00027)  
http://www.oig.hhs.gov/oas/reports/region5/50800027.pdf

Of the 169 high-dollar payments that the National Government Services made to hospitals for inpatient services for calendar years 2004 through 2006, 95 payments included net overpayments totaling $19.9 million.  At the start of the OIG's audit, hospitals had refunded overpayments totaling $19 million for 2 claims and not refunded net overpayments totaling $675,000 for 93 claims.

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 

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