Federal Reports

The Florida Agency for Health Care Administration (State agency) did not always suspend Medicaid payments to providers that had credible fraud allegation cases in accordance with the Social Security Act. Of the 95 cases that we reviewed, the State agency applied a good-cause exception not to suspend payments for 1 case; and it either suspended, pursued recovery, or otherwise did not make Medicaid payments to providers related to 40 other cases.

For Federal fiscal years 2010 through 2013, the California Department of Health Care Services (State agency) claimed $58.3 million in Federal reimbursement for Medicaid overpayments that it made to providers who were determined to be bankrupt or out of business (uncollectible overpayments). The State agency complied with Federal requirements when reclaiming Federal Medicaid reimbursement for uncollectible overpayments. However, the State agency incorrectly used increased Federal medical assistance percentages (FMAPs) authorized under the American Recovery and Reinvestment Act to claim additional Federal reimbursement of $6.6 million for uncollectible overpayments that were not originally made during the recession adjustment period (October 1, 2008, through June 30, 2011) or were not previously refunded to the Federal Government using the increased FMAPs.

All 100 of the New Jersey Department of Human Services' (State agency) sampled claims for Federal Medicaid reimbursement for partial hospitalization services did not comply with Federal and State requirements, and 92 contained more than 1 deficiency. Partial hospitalization services are provided on a hospital-outpatient basis to adults with serious mental illnesses to prevent inpatient hospitalization and achieve community integration. On the basis of our sample results, we estimated that the State agency improperly claimed at least $30.7 million in Federal Medicaid reimbursement for partial hospitalization services that did not meet Federal and State requirements.

The Office of the Inspector General (OIG) received an EmPowerline complaint on January 4, 2016, alleging a chilled/hostile working environment in Operations at Watts Bar Nuclear (WBN) plant. The OIG investigated the allegation and communicated information related to the chilled work environment to the Nuclear Regulatory Commission (NRC). On March 23, 2016, the NRC issued TVA a chilled work environment letter (CWEL) and required TVA to conduct a root cause analysis and take other actions. Due to the technical nature of the issues, the OIG engaged a consulting firm with expertise in the nuclear power industry, NTD Consulting Group, LLC (NTD) to (1) assess whether TVA's analyses of its April 22, 2016, response to the NRC CWEL were thorough and adequate; and (2) review the history of nuclear safety culture issues at TVA for the past several years. In summary NTD found: •TVA's two analyses were incomplete and inadequate, as was TVA's April 22, 2016 response to the NRC CWEL.•TVA's planned corrective actions to address the chilled work environment are unlikely to have long-term effectiveness or sustainability and the probability of success will remain low until an independent and critical evaluation is conducted, and the associated changes are embraced throughout the organization.•The precursors of the chilled work environment went unrecognized by management, internal and external oversight groups, and TVA barrier programs and processes such as the corrective action program, the Employee Concerns Program, Quality Assurance, Nuclear Safety Culture Monitoring Panel, and the Nuclear Safety Review Board which are the programmatic barriers put in place to detect such precursors.•Documentation, data, and interview results indicate TVA management has inappropriately influenced the outcome of causal analyses and independent investigations pertaining to nuclear safety culture/safety conscious work environment issues at WBN.The amount of stress and fear noted in the survey comments over the past several years, as well as current interviews undertaken by OIG, and the recent NRC inspections and TVA commissioned independent assessment results, are atypical of an organization on its way to improved performance, but rather, one that could well reach negative outcomes. It is imperative that the trust issues be addressed and remedied to permit other corrective actions to be successful. Unless and until TVA addresses the harassment, intimidation, retaliation, and discrimination (HIRD) behaviors of management (WBN senior leadership team and others), TVA will not be able to overcome the trust issues at WBN. In response to NTD's report, TVA management generally agreed with the recommendations and noted that a number of corrective actions were taken or are underway since the first draft of the report was issued. Additionally, TVA management reiterated that they "previously stated to the OIG and, more importantly, to the NRC, its belief that there is a chilled work environment at WBN 1. Moreover, TVA has expressly acknowledged management's role in creating the condition and its responsibility for correcting it."