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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
CGS Administrators, LLC, Did Not Claim Some Allowable Medicare Administrative Contract Postretirement Benefit Costs
CGS Administrators, LLC, did not claim $6,000 of allowable Medicare postretirement benefit costs that on its Incurred Cost Proposals for calendar years 2010 and 2011.
The House Committee on Energy and Commerce's Subcommittee on Oversight and Investigations and Subcommittee on Health requested that the U.S. Department of Health and Human Services, Office of Inspector General, provide information regarding the Centers for Medicare & Medicaid Services' (CMS) automated system for processing financial assistance payments (e.g., advance premium tax credits and cost-sharing reductions). This briefing document presents our initial review of the design and implementation of CMS's automated system from May 1 through October 31, 2016. As of May 2016, CMS has fully implemented the automated system for the Federal marketplace and plans to fully transition issuers operating through State marketplaces to the automated system in 2018.
Healthcare Inspection – Alleged Patient Deaths and Management Deficiencies in Home Based Primary Care, Beckley VA Medical Center, Beckley, West Virginia
A Missouri physical therapy practice (the Therapy Practice) claimed Medicare reimbursement for some outpatient physical therapy services that did not meet Medicare reimbursement requirements. Of the 100 beneficiary days in our random sample, the Therapy Practice properly claimed Medicare reimbursement on 65 beneficiary days. The Therapy Practice improperly claimed Medicare reimbursement on the remaining 35 beneficiary days. On the basis of our sample results, we estimated that the Therapy Practice improperly received at least $151,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements. Accordingly, we made procedural and monetary recommendations to the Therapy Practice.
Before the start of our audit, the Iowa Department of Human Services, Iowa Medicaid Enterprise (State agency), did not invoice rebate-eligible physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations (MCOs) in the State. Specifically, the State agency did not invoice drug manufacturers for rebates totaling $709,000 ($401,000 Federal share). These errors occurred because the State agency was still in the process of developing policies and procedures to ensure that it accurately invoiced manufacturers to collect rebates for physician-administered drugs dispensed to enrollees of MCOs.
