Federal Reports

OIG evaluated controls over the health care enrollment program administered at VA medical facilities and determined if enrollment actions were processed timely and supported by required documentation. OIG found that VHA did not provide effective governance necessary to ensure oversight and control over the health care enrollment program medical facilities. Specifically, VHA required medical facilities to establish procedures for processing enrollment applications without implementing effective processes to monitor those activities. Only 38 of 106 VA medical facilities sampled had local enrollment policies. Medical facilities that did have guidance were permitted to adopt practices that were inconsistent with national policies. Conflicts between local practices and national policies occurred because VHA lacked appropriate guidance, oversight, and monitoring to ensure a standardized enrollment process. Formal training was also not provided to eligibility and enrollment staff at VA medical facilities. OIG also found that data systems did not have the capability to identify new enrollment applications or provide the basis for independent testing of timeliness or supporting documentation. Based on a statistical sample, OIG projected that only 197,000 of 427,000 enrollment records in the universe represented FY 2015 applications for enrollment. Further, OIG could not make conclusions related to timeliness or supporting documentation. This occurred because VHA did not adequately monitor program effectiveness or ensure that accurate data were available for program transparency. OIG recommended VHA develop standardized national policy and procedures, implement national oversight, and provide mandatory and standardized training for the health care enrollment program at VA medical facilities. OIG also recommended VHA implement a plan to correct the data integrity issues necessary to improve the accuracy and timeliness of health care enrollment data.

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Seek link below for the full report, report summary, multimedia or any agency follow-up.

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Not all of the direct medical service costs that the Texas Health and Human Services Commission (State agency) claimed for Medicaid School Health and Related Services (SHARS) were reasonable, adequately supported, and otherwise allowable in accordance with applicable Federal and State requirements. Specifically, Fairbanks, LLC (the Contractor), coded random moments incorrectly. Of the 3,161 random moments coded as an Individualized Education Plan-covered direct medical service, 274 were coded incorrectly. As a result of these errors, the State agency received $18.9 million in unallowable Federal reimbursement for the Medicaid SHARS program during the period October 1, 2010, through September 30, 2011.