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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
Nevada Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions
Provider-preventable conditions (PPCs) are certain reasonably preventable conditions caused by medical accidents or errors in a health care setting. Although Federal regulations and the Nevada State plan require Nevada to prohibit, for inpatient hospital services, payment for PPCs that are not present on admission, Nevada’s policies and procedures were not adequate to properly identify PPCs on claims for inpatient hospital services or determine whether payments for claims containing PPCs should have been reduced. As a result, Nevada may have claimed Federal Medicaid reimbursement for inpatient hospital services related to treating certain PPCs.
The October 2018 Semiannual Report to Congress summarizes the Office of Inspector General’s successful work completed from April 1, 2018, through September 30, 2018, to promote excellence, integrity, and accountability within the programs, operations, and management of the U.S. Department of the Interior. Our audit-related activities resulted in total monetary impacts of $101,154,100, with 187 recommendations made and 133 recommendations closed. Our investigative activities resulted in 37 months of jail time, 156 months of probation, and $601,413 in criminal restitution and $600,000 in civil settlements or recoveries.
