Federal Reports

Medicare paid hospitals $372 million for bariatric surgeries provided to Medicare beneficiaries in calendar years 2015 and 2016. Bariatric surgery helps those with morbid obesity to lose weight by making changes to their digestive system. Although OIG has not conducted an audit in this area, the Centers for Medicare & Medicaid Services’ (CMS’s) study of certain bariatric surgery procedure codes found that 98 percent of improper payments lacked sufficient documentation to support the procedures. After analyzing Medicare claim data for bariatric surgery claims with dates of service from January 2015 through December 2016 (audit period), we selected for audit Cedars-Sinai Medical Center (Cedars-Sinai), located in Los Angeles, California. Our objective was to determine whether Cedars-Sinai complied with Medicare requirements and the Medicare contractor’s local coverage determinations (LCDs) and local coverage article (LCA) when billing for bariatric surgeries.Our audit covered $1.3 million in Medicare payments to Cedars-Sinai for 62 bariatric surgery claims. We reviewed the beneficiaries’ medical records to determine whether the claims met Medicare requirements and the specifications in Noridian Healthcare Solutions, LLC’s (Noridian’s) LCDs and LCA for bariatric surgery. An independent medical review contractor reviewed the medical records for 23 claims.

An Amtrak coach cleaner in Chicago, Illinois, was terminated from employment on October 14, 2020, following her administrative hearing. The former employee participated in a medical fraud scheme in violation of company policies. Our investigation found that the former employee provided a chiropractor based in Dolton, Illinois, with her medical and personally identifiable information and that of her dependents in exchange for cash kickbacks. The chiropractor used the information to fraudulently bill Amtrak’s health insurance plan for services that were not provided.

The United States Capitol Police (USCP) Office of Inspector General (OIG) Strategic Plan for FY 2014-2019 sets forth our mission, vision, and goals for 5 years. OIG plans to provide positive return on U.S. taxpayer investments by asking the following critical questions of work we plan to undertake: Are we addressing the most important matters? Are we adding value, achieving positive change, or significant results? And, are we making USCP programs and operations more efficient and effective?

FY 2020 management and performance challenges.