Federal Reports

Illinois improperly claimed $149,000 in Federal Medicaid reimbursement over a 2-year period for inpatient hospital services related to treating certain provider-preventable conditions. In addition, Illinois improperly reduced Federal Medicaid reimbursement by $52,000 for inpatient hospital services that did not relate to treating provider-preventable conditions

Although the Washington State Health Care Authority (State agency) made Medicaid electronic health record (EHR) incentive program payments to eligible hospitals, it did not always make these payments in accordance with Federal requirements. Specifically, from October 1, 2011, through December 31, 2015, the State agency made incorrect Medicaid EHR incentive payments to 19 of the 20 hospitals reviewed, totaling $11.3 million. These incorrect payments included both overpayments and underpayments, resulting in a net overpayment of $9.2 million. Because the incentive payment is calculated once and then paid out over 4 years, payments made after December 31, 2015, will also be incorrect. The adjustments to these payments total $2.5 million.

The Enterprise Project Management Office (EPMO) is responsible for the development and deployment of project management processes, systems, tools, and training to project organizations within Generation Construction, Projects, and Services, as well as TVA fleet-wide. Additionally, the EPMO is responsible for evaluating project performance. The OIG assessed the strengths and risks that could impact the organizational effectiveness of the EPMO. Our review found the EPMO to be effective in achieving its current goals and objectives. To meet its responsibilities, the EPMO has deployed project management guidance, risk assessment tools, and a project lessons learned database and is currently developing an integrated suite of project management tools. Our review identified strengths related to (1) organizational alignment, (2) trust and accountability, (3) management support of employees and (4) employee engagement. We also identified an inherent risk pertaining to organizational resistance to change that if not well mitigated, could threaten the mission of the EPMO, as well as the potential for sustainable project management culture change across TVA. EPMO is in the process of mitigating this risk. As a result of actions recently taken by the EPMO to mitigate risks to alignment, execution, and engagement, no recommendations were made.

The Reports Consolidation Act of2000 (RCA)1 authorizes the CFfC to provide financial and performance information in a meaningful and useful format for Congress, the President, and the public. The RCA requires the Inspector General to summarize the "most serious" management and performance challenges facing the Agency and to assess the Agency's progress in addressing those challenges.2 This memorandum fulfills our duties under the RCA.