An official website of the United States government
Here's how you know
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock (
) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
Wisconsin Physicians Service Insurance Corporation Did Not Properly Settle Indiana Medicare Disproportionate Share Hospital Cost Report Payments
With respect to Medicaid patient days, Wisconsin Physicians Service (WPS) did not properly settle Medicare cost reports submitted by Indiana hospitals for Medicare disproportionate share hospital (DSH) payments in accordance with Federal requirements. The 48 selected providers improperly claimed a total of 14,325 Medicaid patient days on their Medicare cost reports, resulting in DSH overpayments totaling $6.1 million. These improper claims included both unallowable and unsupported patient days and involved separate Child Health Insurance Program (S-CHIP) recipients, Aid to Residents in County Homes (ARCH) recipients, 590 Program recipients, and dual eligibles.
Claims for outpatient physical therapy services provided by a physical therapy practice (the practice), located in Yuba City, California, did not comply with Medicare requirements. Specifically, of the 100 beneficiary days in our random sample, the practice properly claimed Medicare reimbursement for 36 beneficiary days. However, the practice improperly claimed Medicare reimbursement for the remaining 64 beneficiary days, consisting of 62 beneficiary days that had therapy services that were not medically necessary and 2 beneficiary days that did not meet Medicare documentation requirements. On the basis of our sample results, we estimated that the practice received at least $583,000 in unallowable Medicare reimbursement for outpatient physical therapy services that did not comply with Medicare requirements.
The OIG updated the agency's top management challenges, issued a mandatory report to the Congress on the status of NEA’s implementation of the Cybersecurity Act of 2015, issued a report on our review of a Single Audit involving an NEA grantee, and collaborated with the NEA to establish a more collaborative and disciplined audit follow-up process to facilitate resolution of OIG recommendations. Finally, we referred two Freedom of Information Act requests to NEA for processing, evaluated seven hotline inquiries and took appropriate action to address the inquires, and completed a policy review as required by the IG Act. The annual financial statement and FISMA audits are in progress and will be completed by their respective deadlines.
