Federal Reports

Hidalgo Medical Services (HMS), in Lordsburg, New Mexico, did not comply with all applicable Federal requirements and grant terms related to its Patient Protection and Affordable Care Act-funded capital development grant.

We noted that the Massachusetts Department of Elementary and Secondary Education’s oversight of LEA single audit resolution was notsufficient to ensure that LEAs took timely and appropriate corrective action. We found that in many cases the Massachusetts Department of Elementary and Secondary Education did not identify and require appropriate corrective actions for LEAs to take to adequately resolve their findings. Additionally, the Massachusetts Department of Elementary and Secondary Education did not have a tracking process for individual LEA findings and did not follow up on the status of corrective actions for many of the repeat findings covered by our review. We also noted that the Massachusetts Department of Elementary and Secondary Education generally did not communicate effectively with LEA officials regardingaudit resolution, and none of the Massachusetts Department of Elementary and Secondary Education’s management decision letters that were reviewed met all Federal requirements for content.

Total Renal Laboratories, Inc. (TRL), did not always comply with Medicare requirements for tests billed with an AY modifier for beneficiaries with end-stage renal disease (ESRD). Specifically, for 60 of the 100 beneficiary-days, TRL submitted separate claims using the AY modifier for tests furnished for the treatment of ESRD contrary to the consolidated billing requirement. In addition, TRL did not always comply with other Medicare requirements. These errors occurred primarily because TRL did not have adequate controls to comply with certain Medicare requirements. On the basis of our sample results, we estimated that Medicare overpaid TRL at least $1.2 million for tests that were furnished for the treatment of ESRD.

DVA Laboratory Services, Inc. (DVA), did not always comply with Medicare requirements for tests billed with an AY modifier for beneficiaries with end-stage renal disease (ESRD). Specifically, for 62 of the 100 beneficiary-days, DVA submitted separate claims using the AY modifier for tests furnished for the treatment of ESRD contrary to the consolidated billing requirement. In addition, DVA did not always comply with other Medicare requirements. These errors occurred primarily because DVA did not have adequate controls to comply with certain Medicare requirements. On the basis of our sample results, we estimated that Medicare overpaid DVA at least $989,000 for tests that were furnished for the treatment of ESRD.