Federal Reports

Quarterly Summary Memorandum to the Lead Inspector General, Department of Defense

For a covered outpatient drug to be eligible for Federal Medicaid reimbursement, the manufacturer must enter into a rebate agreement administered by the Centers for Medicare & Medicaid Services (CMS) and pay quarterly rebates to the States. Previous OIG audits found that States did not always bill and collect all rebates due for drugs administered by physicians to enrollees of Medicaid managed-care organizations (MCOs).

The Medicaid "health home" option allows States to create programs that provide care coordination and care management for Medicaid beneficiaries with chronic health conditions. Health homes are not physical spaces. Rather, they are a healthcare model based on the idea that several providers can work together to coordinate and manage beneficiaries' care and, in doing so, provide quality care at a reasonable cost.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The Federal Emergency Management Agency’s (FEMA) Individuals and Households Program (IHP) has a robust process for collecting and verifying information provided by underinsured disaster applicants. However, FEMA does not collect sufficient supporting documentation or verify applicants claiming to have no insurance are eligible for home repair assistance. Rather, according to FEMA, it relies on applicant self-certifications because no comprehensive repository of homeowner’s insurance data exists, and any additional verification processes would delay home repair payments. As a result, FEMA made and we are questioning, more than $3 billion in improper and potentially fraudulent payments to individuals since 2003. Additionally, FEMA did not properly assess and report improper payment risks within IHP because it disregarded significant internal control deficiencies and prior audit findings when it evaluated program risks. Therefore, IHP applicants who claimed no homeowner’s insurance received less oversight even though they posed the greatest risk for improper and fraudulent payments. Without implementing changes to its home repair assistance processes, FEMA cannot ensure it is being a prudent steward of Federal resources and adequately assessing its risks of improper payments and fraud. We made two recommendations to FEMA to improve its IHP home repair documentation, verification, and risk management processes. FEMA non-concurred with the two report recommendations, resulting in both recommendations being unresolved and open.