Federal Reports

John Mckoy pleaded guilty in U.S. District Court, Eastern District of Pennsylvania, on June 14, 2019, to multiple health care fraud charges related to involvement in a scheme to defraud a health care benefit plan, which provided coverage to Amtrak employees and their dependents. McKoy was the owner and operator of several neighborhood health care facilities, including Mt. Pleasant Medical Management, Inc. and Harris Medical Management, Inc. Between November 2004 and October 2007, McKoy submitted, and caused to be submitted, hundreds of false and fraudulent claims to United Health Care Corporation totaling more than $321,000 for services purportedly rendered to predominately Amtrak patients who were never seen or treated for those services. McKoy’s fraud caused Amtrak a loss of approximately $291,000.This joint investigation was conducted with the U.S. Postal Inspection Service, Department of Labor OIG and the Federal Bureau of Investigation.

A previous OIG report found that, in 2009 and 2010, Delaware did not comply with Federal requirements to report all Medicaid overpayment collections. The report had five recommendations that were still unimplemented as of June 30, 2017.Our objective was to determine whether Delaware implemented recommendations from our previous review and is in compliance with Federal requirements for reporting Medicaid overpayments.

This report fulfills for 2019 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA). The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). These individuals generally get drug coverage through Medicare Part D. Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the ninth report that OIG has produced to meet this mandate.

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The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess Veterans Health Administration (VHA) facilities’ utilization of clinical pharmacists who work under a scope of practice in a mental health outpatient care setting. After reviewing relevant policies and conducting interviews, the OIG found that mental health clinical pharmacists’ (MHCPs’) independence levels were not clearly identified by staff or facilities’ bylaws. Guidance provided conflicting instructions regarding requirements for collaborating agreements and lacked provision for oversight by a specific physician. Facilities’ scopes of practice were inconsistent in describing delegated duties that were specific to mental health. VHA policy was insufficient to ensure the chief of mental health reviews and endorses MHCPs’ scopes of practice. Referral processes were not clear or standardized regarding how diagnoses were conveyed to MHCPs or whether involvement of a licensed independent practitioner with prescriptive authority was considered to determine appropriateness for patients’ referrals. VHA policy does not require a defined process to consider patient’s clinical complexity and policies lacked guidance instructing MHCPs on when or how to refer patients to a higher level of care. The OIG made nine recommendations to the VHA Under Secretary for Health related to autonomy, collaborating agreements, collaborating with licensed independent practitioners with prescribing authority, scopes of practice, and referrals.