Federal Reports

Intensity-modulated radiation therapy (IMRT) is an advanced type of radiation procedure used to treat difficult-to-reach tumors. Novitas Solutions, Inc. (the Medicare Administrative Contractor responsible for processing Medicare payments for outpatient services in Jurisdictions H and L), incorrectly paid hospitals for IMRT services provided to nearly all of the beneficiaries associated with our review.

Since 2003, the United States Government Accountability Office has identified Medicaid as a high-risk program. Between Federal fiscal years (FYs) 2011 and 2017, Medicaid expenditures rose 42 percent from $430 billion to $610 billion. By FY 2025, Medicaid is projected to have annual expenditures of $958 billion. The Social Security Act requires States to provide at least 40 percent of the non-Federal share of Medicaid expenditures, while up to 60 percent may be derived by local sources, including health-care-related taxes, as long as the taxpayer is not held harmless for the tax payment. However, this cost sharing requirement only applies to the aggregate of annual Medicaid program expenditures, not on a service-specific basis.

OIG audited the consolidated financial statements of FNS for fiscal years 2018 and2017.

OIG audited the consolidated financial statements of Rural Development for fiscal years 2017 and 2018.

OIG audited FCIC/RMA’s financial statements for fiscal years 2018 and 2017

We reviewed the California State agency’s controls for operating under the Summer Food Service Program requirements and sponsor and site compliance with those requirements. We have reported our separate findings in an interim report dated September 2017 and this final report.

What We Looked AtUnmanned Aircraft Systems (UAS) represent a substantial economic and technological opportunity for the United States. To advance the safe integration of commercial UAS into the National Airspace System (NAS), the Federal Aviation Administration (FAA) published a rule for small UAS in June 2016. However, the rule does not permit several operations that are highly valued by industry but considered to be higher risk, such as operating beyond line of sight or over people. To accommodate these operations, the rule allows FAA to issue waivers. Given the significant safety implications of integrating UAS into the NAS and an increase in the number of both requested and approved UAS waivers, we initiated an audit of FAA's approval and oversight processes for UAS waivers. Specifically, our objectives were to assess FAA's processes for (1) granting waivers under the rule for small UAS operations and (2) conducting risk-based oversight for UAS operators with waivers.What We FoundFAA established processes for reviewing and granting waivers but has experienced difficulties obtaining sufficient information, managing the volume of requests, and communicating with applicants, particularly in explaining reasons for denying requests. As a result, FAA's Flight Standards office has disapproved 73 percent of operational waiver requests (e.g., over people and beyond line of sight), and a significant backlog of waiver requests to operate in airspace with manned aircraft exists. Although the Agency has improved its guidance and processes, FAA may continue to experience difficulty with review timeliness and responsiveness, given the growing demand for UAS operations, which could increase the risk that operators may continue to bypass established processes and operate without Agency approval. Further, FAA is still in the early stages of developing a risk-based oversight system for UAS operations. While FAA has developed guidance for planning annual inspections, few UAS operators have received inspections to verify their compliance with regulations and the terms of their waivers. Moreover, the Agency's ability to perform meaningful risk-based surveillance is hindered by limited access to detailed UAS operator, FAA inspection, and risk data. As a result, FAA does not have assurance of operators' compliance with regulations, is not well-positioned to develop an oversight strategy, and is missing opportunities to gather information that will help shape rulemaking and policies.Our RecommendationsWe made eight recommendations to the Federal Aviation Administrator regarding strengthening the Agency's review and oversight processes for UAS waivers. FAA concurred with seven of our recommendations and partially concurred with one recommendation.