Federal Reports

For the Medicare Advantage (MA) program, CMS contracts with private insurance companies, known as MA organizations (MAOs), to provide Medicare coverage for 18.6 million beneficiaries. In fiscal year 2016, MA expenses reached $200 billion. In 2012, CMS began collecting detailed information from MAOs regarding each service provided to MA beneficiaries. This information is known as MA encounter data. These data must be accurate for CMS to review the medical care that beneficiaries are receiving and use the data to increase payments to MAOs for beneficiaries in poorer health. Ensuring the completeness, validity, and timeliness of the MA encounter data is also critical to safeguard program integrity and to ensure that MA beneficiaries receive needed medical care.

The OIG investigated allegations that a BIA manager had sexually harassed his direct subordinate.The employee and two other women, both of whom had reported to the manager in the past, told us that he had subjected them to unwelcome and inappropriate touching or sexual remarks. The employee said the manager touched her inappropriately and made unwelcome remarks of a sexual nature to her. The second woman, also a BIA employee, said the manager had made inappropriate remarks to her when she worked for him. The third woman, who no longer worked for the BIA, said that when she worked for the manager he had regularly hugged her when she did not want him to.When we interviewed the manager, he denied most of the allegations against him, but he later admitted it was possible he had made an inappropriate remark to the first employee. The manager left the Department after we began our investigation.We also found during our investigation that two regional BIA managers knew about some of the manager’s alleged misconduct and should have acted sooner to address it.

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