Federal Reports

A prior OIG audit found that Medicare paid providers that had billed for medically unnecessary laboratory tests. Our preliminary review of Medicare claims identified providers that billed for direct-measurement, low-density lipoprotein (LDL) cholesterol tests (direct LDL tests) and lipid panels (a blood test that reports four measures of lipids, including LDL cholesterol) for the same beneficiary on the same date of service; some of these providers billed the direct LDL test every time they billed the lipid panel. These claims were at risk of noncompliance with Medicare requirements because, according to the Centers for Medicare & Medicaid Services (CMS), billing for a direct LDL test in addition to a lipid panel, while sometimes medically necessary, should happen with only limited frequency.Our objective was to determine whether payments made to providers for direct LDL tests that were billed in addition to lipid panels for the same beneficiary on the same date of service complied with Medicare requirements.Our audit covered Medicare Part B payments of about $35 million for direct LDL tests that were billed in addition to lipid panels for the same beneficiary on the same date of service and that had dates of service from 2015 through 2019 (audit period).

The objective of our audit was to determine whether the Office for Civil Rights (OCR) dismissed discrimination complaints in accordance with applicable policies and procedures. Specifically, we determined whether (1) complaints initially dismissed as a result of the March 2018 revision to OCR’s Case Processing Manual (CPM) have been reopened and reviewed and (2) the revised complaint dismissal process was conducted as provided in OCR’s November 2018 revision to the CPM. We were unable to determine whether complaints that were dismissed because of the March 2018 CPM revisions have been reopened and reviewed. We found that OCR needs to improve its tracking related to the reopening of complaints previously dismissed under Section 108(t) of the March 2018 CPM. We found no indication that complaints were not being dismissed in accordance with revisions made to the November 2018 CPM. We also found that complaints dismissed because of the March 2018 CPM revisions were generally dismissed in accordance with policy. However, we did find that some complaints dismissed under Section 108(t) did not always meet the criteria for dismissal, some complaints that did meet the criteria for a dismissal under Section 108(t) were not always dismissed, and case files did not always contain required documentation. In addition, we found that several of the complaints dismissed were already in an active resolution phase and/or an investigation had been completed.

For our evaluation of USPTO’s Patent Trial and Appeal Board (PTAB) operations, the objectives were to (1) assess PTAB’s processes; (2) identify risk areas within PTAB; and (3) identify any internal and external challenges PTAB faces, and the significance and impacts of these challenges. We contracted with The MITRE Corporation (MITRE)—an independent firm—to perform this evaluation. Our office oversaw the progress of this evaluation to ensure that MITRE performed the evaluation in accordance with the Council of the Inspectors General on Integrity and Efficiency’s Quality Standards for Inspection and Evaluation (December 2020) and contract terms. However, MITRE is solely responsible for the attached report and conclusions expressed in it.

We investigated allegations that an oil and gas production company claimed improper allowances for offshore Federal mineral leases in the Pacific Ocean. The company submitted royalty refund requests to the Office of Natural Resources Revenue (ONRR) for previously unclaimed oil and gas transportation allowances and gas processing allowances. The royalty refund requests raised suspicion at ONRR because the company had not claimed such allowances previously and because the royalty refund requests covered the regulatory maximum allowable period of 6 years.We found the company’s royalty refund requests were incorrect and poorly documented; however, we found no evidence the company intended to deceive or defraud ONRR. We found the company submitted claims on incorrect forms, improperly designated expenses associated with a pipeline it owned, and failed to provide ONRR with source documents that fully supported its royalty refund requests.We also found that the company owes unpaid mineral royalties to ONRR. The company reduced current Federal mineral royalty payments submitted to ONRR in an attempt to recoup funds included in its prior requests in anticipation that ONRR would eventually approve its claims for payment. As of April 2021, ONRR had denied the company’s royalty refund requests pending further review, and ONRR is continuing to work with the company to either approve the refund claims or recover any unpaid Federal mineral royalties.