Federal Reports

Selected General Information System Controls at the Railroad Retirement Board Were Not Always Adequate

Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies. Our prior reviews of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who were not confined to the home (homebound) or were not in need of skilled services. Our objective was to determine whether EHS Home Health Care Service, Inc. (EHS), complied with Medicare requirements for billing home health services on selected types of claims.

The Postal Service uses Negotiated Service Agreements (NSAs) to better meet customer needs in the highly competitive parcel shipping market. The number of NSAs has grown from several dozen in 2012 to more than 1,000 as of 2018. These agreements must be approved by the Postal Regulatory Commission (PRC). Of the more than 1,400 domestic package agreements submitted to the PRC for review since 2006, all of them have been approved. While the regulatory bar is relatively low, the process for developing, approving, and managing NSAs is complex.