Federal Reports

Top management challenges report.

Total Sleep Management, Inc. (Total Sleep), an Independent Diagnostic Testing Facility, based in Orlando, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries, Total Sleep billed Medicare claims for polysomnography services that met Medicare billing requirements for 21 beneficiaries with 38 corresponding lines of service. However, Total Sleep billed Medicare claims for the remaining 79 beneficiaries with 111 corresponding lines of service that did not meet Medicare requirements, resulting in overpayments totaling $51,000.

The internal controls of the Kentucky Health Benefit Exchange (Kentucky marketplace) were generally effective in ensuring that individuals were enrolled in qualified health plans (QHPs) according to Federal requirements. However, we identified deficiencies with maintenance of identity-proofing documentation, verification of eligibility for minimum essential coverage, and resolution of inconsistencies in eligibility data. QHPs are private health insurance plans that each marketplace recognizes and certifies as meeting certain participation standards and covering a core set of benefits.