Federal Reports

Rhode Island did not ensure its Medicaid managed-care organizations (MCOs) complied with Federal and State requirements prohibiting Medicaid payments to providers for inpatient hospital services related to treating certain provider-preventable conditions (PPCs). PPCs are certain reasonably preventable conditions caused by medical accidents or errors in a health care setting. For our audit period, we identified that MCOs paid providers approximately $4 million for 241 claims that contained PPCs. Rhode Island's internal controls were not adequate to ensure that its MCOs complied with Federal and State requirements. For instance, Rhode Island did not follow up with the MCOs to determine why present on admission codes were missing or whether the payments made for the related claims complied with Federal and State requirements. In addition, the MCOs did not have policies or procedures to identify PPCs on claims for inpatient hospital services or determine whether payments for claims containing PPCs should have been reduced. As a result, the unallowable portion of the $4 million identified for our audit period was included in the capitation payment rates for State fiscal years 2017 and 2018.

In FY 2017, CIGIE continued to meet its mandated missions, and through this report, we present CIGIE’s accomplishments in FY 2017 reflecting our efforts in meeting our mandate. Together, the work of the OIG community resulted in significant improvements to the economy and efficiency of programs Governmentwide, with potential savings totaling approximately $54.6 billion. With the OIG community’s aggregate FY 2017 budget of approximately $2.5 billion, these potential savings represent about a $22 return on every dollar invested in the OIGs. In Background, we summarize the Council’s history and the Inspector General Empowerment Act of 2016, the most recent enhancement to the Inspector General Act of 1978. We also discuss some of the accomplishments of CIGIE’s standing committees in FY 2017. Then, in Strategic Plan Business Goal Accomplishments, we describe CIGIE’s accomplishments under FY 2017’s three major strategic business goals. Next, we summarize current issues of concern to CIGIE members in Key Legislation Affecting the IG Community and Shared Management and Performance Challenges. We then offer perspective on IG Community Accomplishments and provide Contact Information for CIGIE Members. Finally, we recognize the recipients of the most noteworthy 2017 CIGIE Awards.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements