Federal Reports

This audit is one of a series of audits to determine whether States had recovered, and returned the correct Federal share of, improper Medicaid claims amounts and damages. For this audit, we focused on Nebraska’s Medicaid Fraud Control Unit (MFCU) actions related to Medicaid overpayments from legal judgments and settlements that the State had pursued under relevant Medicaid fraud statutes. Nebraska is required to report recoveries for these MFCU-determined Medicaid overpayments to the Centers for Medicare & Medicaid Services (CMS) and to refund the Federal share to the Federal Government.Our objective was to determine whether Nebraska reported and returned the correct Federal share of MFCU-determined Medicaid overpayments identified during the period October 1, 2011, through September 30, 2018.

Why OIG Did This AuditThe Medicare hospice benefit allows providers to claim Medicare reimbursement for hospice services provided to individuals with a life expectancy of 6 months or less who have elected hospice care. Previous OIG audits and evaluations found that Medicare inappropriately paid for hospice services that did not meet certain Medicare requirements.Our objective was to determine whether hospice services provided by Professional Healthcare at Home, LLC (Professional Healthcare), complied with Medicare requirements.How OIG Did This AuditOur audit covered 3,458 claims for which Professional Healthcare (located in Fairfield, California) received Medicare reimbursement of $20.3 million for hospice services provided from April 1, 2016, through March 31, 2018. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

An Amtrak coach cleaner based in Chicago, Illinois, was terminated from employment on June 10, 2021, following his administrative hearing. Our investigation found that the former employee violated company policy by failing to report his arrest and conviction for driving under the influence and failing to report two other criminal convictions while employed by the company.