Federal Reports

A Florida physical therapy practice (the Therapy Practice), located in Boca Raton, Florida, properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days that we sampled. However, the Therapy Practice improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days. These deficiencies occurred because the Therapy Practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements.

The Office of Inspector General (OIG) administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess the Units' adherence to the 12 MFCU performance standards and its compliance with applicable Federal statutes and regulations.

We found that FSA does not have sufficient oversight of IT projects to provide assurance that its Lifecycle Management Methodology process is appropriately implemented. FSA does not have an accountability mechanism and, as a result, it did not always conduct required technical and management reviews in accordance with the Lifecycle Management Methodology criteria and did not always update project tailoring plans asprojects progressed through their lifecycle. In addition, we found that FSA did not maintain a complete and reliable inventory of IT projects and did not track the progress of all IT projects in its Enterprise Project Portfolio Management system. We concluded that FSA’s lack of an accountability mechanism increased the likelihood of unnecessary risk and costly delays.