Federal Reports

Medicaid telemedicine services are health services delivered via telecommunication systems. A Medicaid patient at an originating site uses audio and video equipment to communicate with a health professional at a distant site. Before the COVID-19 public health emergency, Medicaid programs were seeing a significant increase in payments for telemedicine services and expect this trend to continue. This audit, conducted before the COVID-19 public health emergency, is one in a series of audits to determine whether selected States complied with Federal and State requirements when claiming Federal reimbursement for telemedicine services.Our objective was to determine whether Illinois made payments for Medicaid telemedicine services in accordance with Federal and State requirements.

The Medicaid program pays for nonemergency medical transportation (NEMT) services that a State determines to be necessary for beneficiaries to obtain care. Prior OIG audit reports have consistently identified NEMT services as vulnerable to fraud, waste, and abuse.Our objective was to determine whether Indiana claimed Federal Medicaid reimbursement for NEMT service claims in accordance with Federal and State requirements.

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program’s drug rebate requirements, manufacturers must pay rebates to the States. States bill the manufacturers for rebates to reduce the cost of drugs to the program. However, previous Office of Inspector General (OIG) audits found that States did not always bill and collect all rebates due for drugs administered by physicians to enrollees of Medicaid managed-care organizations (MCOs). For this audit, we reviewed the Michigan Department of Health and Human Services’ (State agency’s) billing of rebates for both pharmacy and physician-administered drugs dispensed to MCO enrollees. Our objective was to determine whether the State agency complied with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to MCO enrollees.

When an overpayment is identified in Medicare Part A or Part B, providers have the right to contest the overpayment amount using the Medicare administrative appeals process. If a statistical estimate of an overpayment (an extrapolated overpayment) is overturned during the administrative appeals process, then the provider is liable for the overpayment identified in the sample but not the extrapolated amount. Given the large difference between overpayment amounts in the sample and extrapolated amounts, it is critical that the process for reviewing extrapolations during an appeal is fair and reasonably consistent. In the first and second levels of the appeals process, such extrapolated overpayments are reviewed by Medicare administrative contractors (MACs) and qualified independent contractors (QICs), respectively.Our objective was to determine whether the Centers for Medicare & Medicaid Services (CMS) ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements.

In accordance with our Annual Performance Plan Fiscal Year 2020, dated October 2019, the Office of Inspector General (OIG) conducted a review of the United States Capitol Police (USCP or the Department) Office of Professional Responsibility (OPR). The scope of the review included existing policies and procedures related to OPR for Fiscal Year (FY) 2019 through March 31, 2020.  OIG objectives were to determine if the Department (1) established adequate internal controls and processes for ensuring compliance with Department policies and (2) complied with policies and procedures, laws, regulations, and best practices.

Our objective was to determine if the Postal Service developed the HERO system in accordance with policies, procedures, and industry best practices, and whether it is functioning as management intended.

National Provider Identifiers (NPIs) for physicians and nonphysician practitioners who order and/or refer services (ordering providers) are essential for safeguarding the program integrity of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); clinical laboratory services; imaging services; and home health services in Medicare. NPIs are critical for identifying inappropriate billing and ordering patterns among providers and investigating fraud and abuse. Both CMS and OIG rely on NPIs for ordering providers to conduct oversight and pursue fraud investigations.