Federal Reports

We conducted this study and its companion, Indian Health Service Hospitals: More Monitoring Needed to Ensure Quality Care (OEI-06-14-00010), in response to concerns about the care provided in IHS hospitals. Reports of inadequate health care services for American Indians and Alaska Natives (AI/ANs) have concerned the Federal Government for almost a century. IHS is responsible for providing health services to the 567 federally recognized tribes of AI/ANs. As part of its service, IHS directly operates 28 acute-care hospitals. IHS requires its hospitals to be accredited by a nationally recognized organization (or Medicare-certified) and to comply with the Medicare Hospital Conditions of Participation (CoPs). OIG is committed to continued work to improve patient care provided in IHS hospitals.

The North Carolina Division of Medical Assistance (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. The State agency used statistically invalid random moment sampling (RMS) in allocating costs to Medicaid, and it did not maintain adequate support to validate its sample results and related extrapolations. In addition, it claimed these costs without promptly submitting to the U.S. Department of Health and Human Services, Division of Cost Allocation (DCA), for review its cost allocation plan (CAP) amendment describing its new random moment timestudy (RMTS) methodology. Instead, the State agency claimed costs based on an implementation plan describing the new RMTS methodology, which was conditionally approved by CMS. As a result, the almost $107.5 million (almost $53.8 million Federal financial participation) the State agency claimed in school-based Medicaid administrative costs for Federal fiscal years 2010 through 2012 was unallowable.

Both the Centers for Medicare & Medicaid Services' (CMS) policies and procedures to ensure that payments are not made for Medicare services rendered to incarcerated beneficiaries and its planned revisions to those policies and procedures did not comply with Medicare requirements.

CMS had policies and procedures to ensure that payments were not made for Medicare services ostensibly rendered to deceased individuals. These policies and procedures generally ensured that CMS did not make improper payments when its data systems indicated at the time a claim was processed that the individual had died before the claimed date of service. These policies and procedures also ensured that CMS correctly identified and recouped improper payments for almost all of the cases in which the Enrollment Database (EDB) was updated with date-of-death information after the claims had been processed and paid.

We conducted this study and its companion, Indian Health Service Hospitals: Longstanding Challenges Warrant Focused Attention to Support Quality Care (OEI 06 14 00011), in response to concerns about the care provided in IHS hospitals. Reports of inadequate health care services for American Indians and Alaska Natives (AI/ANs) have concerned the Federal Government for almost a century. IHS is responsible for providing health services to the 567 federally recognized tribes of AI/ANs. As part of its service, IHS directly operates 28 acute-care hospitals. IHS requires its hospitals to be accredited by a nationally recognized organization (or certified by Medicare) and to comply with the Medicare Hospital Conditions of Participation (CoPs). OIG is committed to continued work to improve patient care provided in IHS hospitals. Upcoming OIG work includes an IHS management review and a medical review focusing on patient safety in IHS hospitals.