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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
Early Alert: Incorporating Medical Device-Specific Information on Claim Forms
We alerted CMS to the preliminary results of our ongoing review of the costs Medicare incurred because of recalled or defective medical devices. Our ongoing review shows that the lack of medical device-specific information in the claims data impedes the ability of CMS to readily identify and effectively track Medicare's total costs related to the replacement of recalled or defective devices.
Not All Internal Controls Implemented by CDC Were Effective in Ensuring That World Trade Center Health Program Pharmacy and Medical Claims Were Paid According to Federal Requirements
The World Trade Center Health Program (WTCHP) is administered by CDC through its National Institute for Occupational Safety and Health (NIOSH). Under the WTCHP, pharmacy benefits and medical services are provided to eligible responders and survivors with certified health conditions related to the September 11, 2001, terrorist attacks.
Michigan Department of Health and Human Services (the State agency) did not always comply with Federal requirements when using a random moment time study (RMTS) to claim direct medical service costs related to Medicaid school-based health services (SBHS). Specifically, the RMTS methodology did not meet acceptable standards because the sample universe from which the State agency selected the sample items was incomplete. The sample universe did not contain all the job titles of the employees whose salaries and wages were allocated on the basis of the sample results. As a result, the State agency received unallowable Federal reimbursement totaling $954,000 for services provided during State fiscal year 2011.
Clinical diagnostic laboratory (lab) tests provide information integral to preventing, diagnosing, and treating disease in millions of Medicare beneficiaries every year. The Protecting Access to Medicare Act of 2014 (PAMA) requires reform of Medicare's payment system for lab tests-the first such reform in 3 decades. Beginning in 2018, Medicare payment rates-which are currently based on inflation-adjusted lab charges-will be replaced with new rates based on current charges in the private health care market. In response to a mandate contained in PAMA, OIG is monitoring Medicare payments for lab tests and CMS's implementation of the new payment system.
