Federal Reports

This audit report is one of a series of OIG reports that addresses the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation's vulnerable populations, including the elderly and individuals with developmental disabilities. OIG is committed to detecting and combating such abuse and neglect. Accordingly, we prepared this audit report after identifying a significant number of Medicare claims submitted for the treatment of injuries related to potential abuse and neglect.

This audit report is one of a series of OIG reports addressing the identification, reporting, and investigation of incidents of potential abuse and neglect of our Nation's most vulnerable populations, including the elderly and individuals with developmental disabilities. Our objectives were to determine (1) the prevalence of incidents of potential abuse or neglect of Medicare beneficiaries residing in skilled nursing facilities (SNFs) who had a hospital emergency room (ER) Medicare claim in calendar year 2016 containing a high-risk diagnosis code, (2) whether these incidents of potential abuse or neglect were properly reported by the SNFs, (3) whether the Centers for Medicare & Medicaid Services (CMS) and State Survey Agencies (Survey Agencies) reported findings of substantiated abuse to local law enforcement, and (4) the extent to which CMS requires incidents of potential abuse or neglect to be recorded and tracked.

From January 1, 2014, through December 31, 2015, Medicare administrative contractors (MACs) nation-wide paid freestanding facilities, facilities affiliated with hospitals, and physicians (collectively referred to as "providers") approximately $800 million for selected polysomnography (a type of sleep study to diagnose and evaluate sleep disorders) services. Previous OIG reviews for polysomnography services found that Medicare paid for services that did not meet Medicare requirements. These reviews identified payments for services with inappropriate diagnosis codes, without the required supporting documentation, and to providers that exhibited patterns of questionable billing.

To determine whether the Social Security Administration (SSA) properly used Medical Improvement Review Standard (MIRS) exceptions, other than failure to cooperate, during continuing disability reviews (CDR) conducted in Calendar Year 2017.

To determine whether the Social Security Administration (SSA) complied with its policies when it paid benefits to minor children.

To determine whether the Social Security Administration (SSA) identified and properly resolved underpayments on prior Supplemental Security Income (SSI) records.

The VA Office of Inspector General (OIG) conducted this review to determine whether the Veterans Benefits Administration (VBA) had adequate controls in place to ensure exempt veterans did not pay VA home loan guaranty funding fees and to refund fees previously charged to exempt veterans. Veterans entitled to receive VA disability compensation do not have to pay funding fees for VA home loans. However, the OIG review team estimated that VA charged about 72,900 exempt veterans about $286.4 million in funding fees between 2012 and 2017. Also, VBA’s Loan Guaranty Service managers that oversee VA’s home loan guaranty program were aware since October 2014 that thousands of exempt veterans may have been charged home loan funding fees. The team estimated VA had not yet given about $189 million in funding fee refunds to about 53,200 exempt veterans. VA also could owe an additional 34,400 veterans refunds of $164 million over the next five years if VBA does not implement adequate controls to prevent inappropriate funding fee charges. The OIG recommended the Under Secretary for Benefits makes certain the Loan Guaranty Service identifies exempt veterans who were charged funding fees and issues refunds, and conducts ongoing periodic reviews. The OIG also recommended the Under Secretary ensures Loan Guaranty Service managers create a plan to minimize and detect inappropriate funding fee charges by updating veteran exemption status in real time, as well as consistently documenting and verifying that lenders apply funding fee refunds to veterans’ loan balances in a timely manner. The Under Secretary provided corrective action plans for all recommendations, with a target completion date of July 31, 2019.

The U.S. Postal Service Office of Inspector General’s (OIG) data analytics identified the Flint, MI, MPO postage and fee refund amount from January 1 through March 31, 2019 as $93,045, compared to $87 from the same period last year. Our objective was to determine whether postage and fee refunds were valid, timely, and properly supported at the Flint, MI, MPO.