Federal Reports

Medicare payments to providers for emergency ambulance transports did not comply or potentially did not comply with Federal requirements. Specifically, Medicare made improper and potentially improper payments totaling $1.9 million: (1) improper payments of $975,154 for transports to destinations that were not covered by Medicare for either emergency or nonemergency ambulance transports, including the identified ground mileage associated with the transports, and (2) potentially improper payments of $928,092 for transports that may not have met Medicare coverage requirements or might have been paid by Medicare as nonemergency ambulance transports. During our audit period (calendar years 2014 through 2016), the Centers for Medicare & Medicaid Services (CMS) did not require the Medicare contractors to implement nation-wide prepayment edits that would either deny payments or mandate prepayment review for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities.

Payments for outpatient intensity-modulated radiation therapy (IMRT) planning services did not comply with Medicare billing requirements. Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning. The overpayments primarily occurred because the hospitals appeared to be unfamiliar with or misinterpreted the Centers for Medicare & Medicaid Services (CMS) guidance. In addition, the claim processing edits did not prevent the overpayments because the edits applied only to services billed on the same date of service as the billing of the procedure code for the bundled payment, and the services in our sample were billed on a different date of service. (Medicare makes a bundled payment to hospitals to cover a range of IMRT planning services that may be performed to develop an IMRT treatment plan.) On the basis of our sample results, we estimated that Medicare overpaid hospitals nation-wide as much as $21.5 million for complex simulations billed during our audit period (for calendar years (CYs) 2013 through 2015). In addition, we identified $4.2 million in potential overpayments for other IMRT planning services that were not included in our sample. In total, Medicare overpaid hospitals as much as $25.8 million during our audit period.

ARC awarded the grant funds to support the renovation of the vacant Willis Building in downtown St. Paul

ARC awarded the grant funds to support the expansion of health care services for under-served populations in Cherokee County and surrounding areas by establishing free clinics and mobile medical services

The grant provided ARC funding to support a project entitled "Connecting People to the West Alabama Automotive Pipeline"

The grant provided ARC funding to support Bevill State Community College (BSCC) in operating the Alabama Appalachian Higher Education (AAHE) Center and implementing project to improve the post-secondary education levels in distressed areas of six Western Alabama counties.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Dayton VA Medical Center, Ohio (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health Care: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-Up; and High-Risk Processes: Central Line-Associated Bloodstream Infections. Three of four Facility leadership positions were filled by interim or acting staff, with long-term Facility leaders in two positions. Organizational leaders supported patient safety and quality care. The OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. The leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve care and performance of selected Quality of Care and Efficiency metrics likely contributing to the current “4-Star” rating. The OIG noted findings in four of eight areas of clinical operations reviewed and issued 10 recommendations attributable to the Chief of Staff and Associate Director. The identified areas with deficiencies were: (1) Quality, Safety, and Value • Completion of inpatient admissions and continued stay reviews • Physician Utilization Management (UM) Advisors’ documentation of decisions • Interdisciplinary review of UM data (2) Credentialing and Privileging • Focused Professional Practice Evaluation processes (3) Environment of Care • Completion of Environment of Care (EOC) rounds • Facility cleanliness and maintenance • Medical equipment safety inspections (4) Long-term Care: Geriatric Evaluations • Program oversight and evaluation • Medical evaluation • Implementation of interdisciplinary plan of care