Federal Reports

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeds the AMP by 5 percent in the 2 previous quarters or 3 of the previous 4 quarters.

This management advisory presents the evaluation results of two 7(a) loans as part of our ongoing High Risk 7(a) Loan Review Program. This is the second in a series of advisories for 7(a) loans we reviewed in fiscal year 2019. The objectives of our evaluation were to determine whether (1) high‐dollar/early‐defaulted 7(a) loans were originated and closed in accordance with the Small Business Administration’s (SBA’s) rules, regulations, policies, and procedures and (2) material deficiencies existed that warrant recovery of guaranteed payments to lenders.Our review of these two high-dollar/early-defaulted 7(a) loans identified that lenders for both loans did not provide sufficient evidence to support that they originated and closed the loans in accordance with SBA’s requirements. Specifically, the lenders did not provide adequate documentation to substantiate reasonable assurance that the borrowers met requirements for eligibility, repayment ability, and equity injection.As a result, the lenders’ material noncompliance with SBA requirements while originating and closing the loans resulted in a combined potential loss to SBA of approximately $2 million. We recommended that SBA require the lenders to bring the two loans into compliance or seek recovery of approximately $2 million. SBA agreed with the recommendations and stated they will contact the lenders to obtain additional information to bring the loan into compliance. If the issues are not overcome, SBA will seek recovery from the lenders.

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder with symptoms of inattention, hyperactivity, and impulsivity. The Department of Health and Human Services publishes national quality measures that outline timeframes for followup care for children with ADHD. Additionally, professional guidelines from American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry describe the importance of followup care and behavioral therapy for these children. Some children may not receive followup care or behavioral therapy for reasons such as limited access to care or because practitioners may be unaware of the professional recommendations. This study focuses specifically on the extent to which children do not receive followup care and behavioral therapy.

We issued this to (1) determine whether the Social Security Administration (SSA) made payments to beneficiaries and representative payees who were deceased according to Florida Department of Health vital records and (2) identify non-beneficiaries in the State file whose death information did not appear in SSA’s records.