Federal Reports

The Cybersecurity Act of 2015 (the Act) requires that each office of inspector general (OIG) submit a report to Congress on the national security systems and systems that provide access to personally identifiable information (PII) operated by or on behalf of its department. The objective of this audit is to examine the IT security policies, procedures, practices, and capabilities—as defined in the Cybersecurity Act of 2015—for national security and PII systems.

New York-Presbyterian Hospital (the Hospital) located in New York, New York, complied with Medicare billing requirements for 162 of the 285 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 123 claims for the audit period (calendar years 2011 and 2012). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $14.2 million for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

CMS established loan agreements with Consumer Operated and Oriented Plans (CO-OPs) to provide startup and solvency loan funding. CMS issued a memo to the CO-OPs in July 2015 allowing the CO-OPs to convert startup loans into surplus notes. A surplus note is a bondlike instrument issued to provide needed capital. Under the terms of a surplus note, CO-OPs are not required to make any repayment on the surplus note that could lead to financial distress or default.

Although the Arizona Health Care Cost Containment System (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 and State requirements. Specifically, from October 1, 2011, through January 31, 2016, the State agency made incorrect Medicaid EHR incentive payments to 24 of the 25 hospitals reviewed, totaling $15 million. These incorrect payments included both overpayments and underpayments, resulting in a net overpayment of $14.8 million. Because the incentive payment is calculated once and then paid out over 4 years, payments made after January 31, 2016, will also be incorrect. The adjustments to these payments total $1.7 million.