Federal Reports

Medicaid plays a critical role in providing behavioral healthcare. Nationally, Medicaid is the single largest payor for behavioral healthcare. In addition, Medicaid enrollees experience a higher rate of behavioral health disorders-which includes both mental health disorders and substance use disorders-than the general population. In spite of the importance of treating such disorders, many Medicaid enrollees encounter significant barriers when accessing behavioral health treatment. The need for behavioral health services is particularly pronounced in New Mexico-a State that has among the highest rates for suicide and deaths from overdose in the Nation. The Office of Inspector General received a congressional request to look into concerns about behavioral health provider shortages and the availability of care for Medicaid managed care enrollees; these enrollees account for most of New Mexico's Medicaid population.

What We Looked AtThe U.S. Equal Employment Opportunity Commission (EEOC) requires Federal agencies to establish anti-harassment programs, which are designed to identify and resolve harassment issues before they become severe and pervasive. We initiated this review after a previous audit identified concerns about the Department of Transportation's (DOT) Operating Administrations' (OA) anti-harassment policies and procedures. Our audit objectives were to assess the extent to which the Department and its OAs (1) have anti-harassment policies and procedures that comply with EEOC guidance and (2) collect and use data on harassment complaints.What We FoundThe DOT policy in place during our audit complied with 13 of 18 EEOC requirements but did not clearly explain prohibited conduct, require the EEO program to inform the anti-harassment program about all harassment allegations, provide for periodic training of managers, provide for periodic training of employees, or create firewalls between the decision makers for the anti-harassment and EEO programs. It also did not require OAs to develop implementation procedures, and the Department and four OAs did not have them, as EEOC requires. One reason for the gaps was EEOC's evolving and expanding oversight of anti-harassment programs--which led the Department to develop its U.S. DOT's Policy Framework for the Prevention of Harassment and Unprofessional Conduct (Policy Framework) over several years, including throughout our audit. In response to our findings, the Department closed all the gaps we identified and issued the Policy Framework on June 21, 2019. Also, while the Department was responsible for collecting, monitoring, and analyzing harassment data for 10 OAs, it did not have a system in place that met EEOC requirements. However, the Policy Framework establishes data collection requirements that may enhance the Department's and the OAs' ability to identify, address, and stop harassment before it becomes severe or pervasive.Our RecommendationsThe Department concurred with our recommendation for improving DOT's anti-harassment procedures. We consider recommendation 1 resolved but open pending completion of the Department's planned actions.

A prior OIG review found that Medicare made improper and potentially improper payments of $1.9 million to providers for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities (SNFs) with dates of service from calendar years (CYs) 2014 through 2016. As part of that review, we identified $3.2 million in payments for emergency ambulance transports from hospitals to SNFs. Because hospitals are capable of providing emergency services, we conducted this separate review of emergency ambulance transports from hospitals to SNFs to determine the appropriateness of billing for them as emergency ambulance transports.