Federal Reports

The New Jersey Department of Human Services (State agency) claimed Federal Medicaid reimbursement for some Global Options for Long-Term Care (GO-LTC) waiver services that did not comply with certain Federal and State requirements. Of the 131 beneficiary-months in our sample, the State agency properly claimed Medicaid reimbursement for all GO-LTC waiver services during 69 beneficiary-months. However, the State agency claimed Medicaid reimbursement for unallowable GO-LTC waiver services during the remaining 62 beneficiary-months. Of the 62 beneficiary-months with services for which the State agency improperly claimed Federal Medicaid reimbursement, 29 contained more than 1 deficiency.

The Texas Health and Human Services Commission (State agency) claimed $72.2 million in expenditures that were not related to eligible noninstitutional long-term services and supports and inappropriately received $1.4 million in Balancing Incentive Payments Program funding. Additionally, the State agency did not calculate or return the family planning Federal share of experience rebates, which totaled $502,000.

The OIG performed this evaluation to determine whether the Nuclear Employee Concerns Program (ECP) was addressing employee concerns in an effective and timely manner for fiscal years 2013 and 2014. In summary, we determined Nuclear ECP generally addressed employee concerns in an effective manner; however, we identified areas for improvement related to documentation, the resolution follow-up process, and reporting to site management. We could not form an overall conclusion related to timeliness in addressing Nuclear ECP cases because there was no defined timeliness goal for some types of cases; however, the Nuclear ECP did not meet its timeliness goal of 45 days for eight of ten sample cases we reviewed that were classified as Concerns (i.e., issues that require ECP to open an investigation). TVA management agreed with our findings and recommendations.