Federal Reports

Medicare paid about $1.9 billion for psychotherapy services provided to beneficiaries nation-wide from July 1, 2015, through June 30, 2017 (audit period). Prior OIG reviews found that Medicare had made millions in improper payments for mental health services, including psychotherapy services. After analyzing Medicare claim data, we selected for review Oceanside Medical Group (Oceanside). Our analysis indicated that providers from Oceanside billed Medicare an average of 33 individual services per day. In addition, two providers each billed for services on all but 5 days during our audit period.

The Affordable Care Act established the Medicare Shared Savings Program (MSSP). Accountable Care Organizations (ACOs) in the MSSP may be eligible to receive shared savings payments from the Centers for Medicare & Medicaid Services (CMS) if they reduce healthcare costs and satisfy the quality performance standard for their assigned beneficiaries. As part of the standard, ACOs must report to CMS complete and accurate data on all quality measures. For performance year (PY) 2016, ACOs reported more than half of the quality measures using the designated CMS web portal. If the reported data were not complete and accurate, the shared savings payments could have been affected. This vulnerability led us to select two ACOs that had consistently received shared savings payments in order to perform an initial risk assessment of ACOs' reporting of data on quality measures through the CMS web portal. This report covers one of those ACOs.

The objective of this report is to summarize key findings identified in 2013 reports and in 2016 followup reports produced by 13 Federal agency Offices of Inspectors General (OIGs) regarding original and derivative classification and Classified National Security Information (CNSI) program management.This summary was produced in response to a request from the CIGIE.

The VA Office of Inspector General (OIG) conducted a healthcare inspection in response to an allegation that a thoracic surgeon (surgeon) provided poor quality of care to five patients. Two other allegations received were addressed in an OIG report published in 2018, Inadequate Intensivist Coverage and Surgery Service Concerns (Report No. 17-03399-150). The surgeon was no longer at the facility. Care concerns identified in two of the five patients had been addressed. The OIG determined that before hiring the surgeon, facility leaders were aware of licensure and malpractice issues, including the relinquishing of a state medical license to prevent continued prosecution in a disciplinary case. Facility leaders were deficient in granting and continuing the surgeon’s clinical privileges without required evidence of competency. Errors during the removal process for the surgeon prevented reporting to the National Practitioner Data Bank and delayed reporting to state licensing boards. The OIG noted weaknesses in quality management processes including the credentialing and privileging of other providers, documentation of basic and advanced cardiac life support certification, administrative closure of electronic health record notes, posting of confidential data to the facility’s internal website, adverse event reporting, completion of institutional disclosure, and administrative investigation board timeliness. The OIG made 18 recommendations related to professional practice evaluation processes, National Practitioner Data Bank and state licensing board reporting, documenting sufficient detail in committee meeting minutes to reflect decision-making, and protecting certain confidential information. Recommendations also centered on reporting events to the Patient Safety Committee, reporting surgery patients’ deaths as required, completing proactive risk assessments, and institutional disclosure and administrative investigation board review processes