Federal Reports

This is a publication by GAO's Inspector General that concerns internal GAO operations. This report addresses the extent to which GAO maintained efficient and effective accountability over personal property acquired with GAO purchase cards.

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (Lerner College) inappropriately drew down some Disaster Relief Act funds and did not implement effective internal controls to monitor Disaster Relief Act funds. Of the $588,000 in Disaster Relief Act funds that we reviewed, $299,000 in funds were drawn down without an immediate cash need for a Hurricane Sandy-related activity. We did not determine whether the Disaster Relief Act funds were used for allowable costs.

The Massachusetts Medicaid program (MassHealth) did not safeguard Medicaid Management Information System (MMIS) data and supporting systems in accordance with Federal requirements. Specifically, MassHealth had vulnerabilities related to security management, configuration management, system software controls, and Web site and database vulnerability scans.

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The Office of Inspector General examined NASA’s efforts to manage its electromagnetic spectrum allocation to communicate with space and science missions amid increasing demands for bandwidth sharing.

We found that the Institute of Education Sciences (IES) did not effectively implement Department requirements for the contractor personnel security screening process. We specifically noted weaknesses in IES’s development of internal policies and procedures, designation of contractpositions and position risk levels, notification and maintenance of security screening decisions and other related information, and inclusion of required contract provisions in contract solicitations. We found that IES staff and officials involved in the process were generally unaware ofDepartment requirements and their related responsibilities for processing contractor employees’ security screenings. We also determined that IES has not ensured that all contractor employees have appropriate security screenings and that security screenings are initiated in a timely manner.

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote correct coding by providers and to prevent Medicare payments for improperly coded services. The NCCI edits include procedure-to-procedure edits that define pairs of HCPCS/Current Procedural Terminology codes (code pairs) that generally should not be reported together for the same beneficiary on the same date of service. One function of the procedure-to-procedure edits is to prevent payments for codes that report overlapping services except in those instances where the services are "separate and distinct" (e.g., different session or patient encounter). Typically, an NCCI edit would prevent the payment for a right heart catheterization (RHC) when billed on the same claim as a heart biopsy. However, under certain circumstances, a hospital may bill and get paid for both services in an NCCI code pair by including a modifier on the claim. If a hospital included modifier -59, it would bypass the NCCI edit and receive payment for both procedures as though they were performed separately. A hospital should not append modifier -59 to the HCPCS code representing an RHC when it is performed with a heart biopsy unless the procedures are separate and distinct.

University of Florida Health Jacksonville (the Hospital) complied with Medicare billing requirements for 133 of the 154 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 21 claims, resulting in net overpayments of $64,000 for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $273,000 for the audit period.

Blue Cross Blue Shield Association, a terminated Medicare contractor, overstated the Medicare segment pension assets by $1 million as of September 30, 2015. In addition, Blue Cross Blue Shield Association understated Medicare's share of the Medicare segment excess pension assets by $161,000 as of September 30, 2015, as a result of the contract termination.

Blue Cross Blue Shield Association did not claim allowable pension costs of $362,000 for Medicare reimbursement for fiscal years 2011 through 2015.

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This work product summarizes an OIG review of allegations of VA waste, fraud, abuse, or mismanagement. The results of the OIG’s oversight efforts are typically published in a formal report. However, the OIG has issued alternative work products, such as this one, in lieu of a full report in certain circumstances. These included instances in which the OIG could not substantiate an allegation or substantiated an allegation without issuing recommendations, when actions were taken by VA during the course of an ongoing project to remediate errors, or when the subject of an allegation retired or resigned from service prior to the completion of OIG's work. In addition, the OIG has issued work products when investigating allegations involving its own personnel when not in the exclusive purview of other agencies.

Mayo Clinic Florida (the Hospital) complied with Medicare billing requirements for 185 of the 199 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in net overpayments totaling $71,000. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors. On the basis of our sample results, we estimated that the Hospital received overpayments of at least $103,000 for the audit period.

Administrative costs received by the Blue Cross Blue Shield Association on its FYs 2010 through 2015 FACPs were generally reasonable, allowable, and allocable and in compliance with Federal regulations. However, we identified $161,000 in unspent termination funds, a $7,000 severance benefit overpayment, and $6,000 in unallowable costs.

Transmittal of the Final Report Assessing the Federal Trade Commission’s Compliance with the Federal Information Security Management Act for Fiscal Year 2016 (Redacted for public release)

New York claimed Federal Medicaid reimbursement for partial hospitalization services claims that did not comply with Federal and State requirements. Specifically, of the 100 claims in our random sample, 59 claims complied with Federal and State requirements, but 41 claims did not. The deficiencies occurred because certain providers did not comply with partial hospitalization program requirements. In addition, although New York performed licensing renewal visits to providers at least every 3 years, these visits were not effective in preventing instances of noncompliance during our audit period. On the basis of our sample results, we estimated that New York improperly claimed at least $4 million in Federal Medicaid reimbursement over 5 years for partial hospitalization services that did not meet Federal and State requirements.

The Texas Health and Human Services Commission did not always claim Federal Medicaid reimbursement for managed care payments in compliance with Federal requirements. Of the 3,170 beneficiary matches in our review, 3,045 were assigned more than 1 Medicaid identification number. As a result, the State agency improperly claimed $6.5 million ($3.8 million Federal share) for managed care payments that did not comply with Federal requirements.

In our previous audits of six Medicare contractors, we found that payments made to providers for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 600 dental services in our 6 stratified random samples, 542 did not comply with Medicare requirements. We did not determine Medicare compliance for 3 dental services because the payments were refunded before our audit work, and we did not determine Medicare compliance for 28 dental services because the providers of those services submitted claims to a different Medicare contractor. Medicare contractors properly paid providers for the remaining 27 dental services. On the basis of these results, we estimated that the six Medicare contractors in our audits improperly paid providers an estimated $9.8 million for hospital outpatient dental services that did not comply with Medicare requirements.

The Nebraska Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NET) services claims submitted by NET providers that did not comply with Federal and State requirements during fiscal years (FYs) 2012 through 2014. On the basis of our sample results, we estimated that the State agency improperly claimed at least $1.9 million (Federal share) in unallowable Medicaid reimbursement for NET services during this period. In addition, NET providers did not have documentation to support that State-mandated driver background checks, vehicle maintenance checks, and driver qualification verifications had been performed.

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This is our audit of the International Trade Administration’s (ITA’s) Enforcement and Compliance’s (E&C’s) efforts to ensure timely and accurate preliminary and final determinations for antidumping duty (AD) and countervailing duty (CVD) proceedings, including investigations and administrative reviews, and the results of regulatory reviews.

Under a contract monitored by the National Credit Union Administration Office of Inspector General, KPMG LLP, an independent certified public accounting firm, performed an audit of the NCUA’s financial statements as of December 31, 2016. This report transmits KPMG's report on its financial statement audit of the NCUA's Temporary Corporate Credit Union Stabilization Fund (TCCUSF) as of and for the years ended December 31, 2016 and 2015.

This report is a follow-up to an interim report we issued on July 11, 2016 regarding TVA's proposed sale of Bellefonte Nuclear Plant site (Evaluation 2016-15376). Under the interim report we determined TVA had taken reasonable actions to date to promote transparency of the sales process and evaluated alternative uses for the site. In addition, we determined TVA appears to have considered the significant risks associated with selling the Bellefonte site. The objective of this follow-up evaluation was to determine if the sale of the Bellefonte site was conducted according to TVA's policies and procedures. We determined the sale complied with most of the steps in TVA's land disposal policies and procedures. However, the sale was a unique transaction that resulted in some deviations from TVA's policies and procedures. Also, we noted some land disposal guidance was outdated.

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined the cost proposal submitted by a contractor for nuclear modifications, outage and supplemental maintenance, and technical support services at TVA's three operating nuclear plants. Our examination objective was to determine if the company's cost proposal was fairly stated for a planned $950 million contract. In our opinion, the company's cost proposal was fairly stated. Specifically, the labor markup rates proposed were supported by the company's actual historical costs.(Summary Only)

We determined that FSA had adopted and implemented new tools and processes in this area in response to the April 2015 closure of one of the largest for-profit education companies in the United States, but further improvements were needed. We reported that FSA needed to improve its processes for reviewing a school’s composite score calculation and any related composite score appeal made by a school. We further noted that FSA needed to implement controls to prevent schools from manipulating composite scores to avoid sanctions or increased oversight by FSA. We concluded that improvements in these areas could better protect students and taxpayers. Specifically, unexpected or abrupt school closures can have significant adverse effects on large numbers of students, including potentially being displaced from their educational program before completion, having credits that cannot transfer to another school, incurring significant student loan debt without obtaining a degree or certificate, and significantly diminished job prospects. Taxpayers are also adversely affected when those types of school closures result in significant volume of loan discharges. We pointed to the financial responsibility provisions that were to have gone into effect in July 2017 as part of the borrower defense regulation changes as including tools to improve the Department’s oversight of schools.

The National Credit Union Administration Office of Inspector General contracted with Moss Adams LLP to conduct a Material Loss Review of six federally insured credit unions (Chester Upland School Employees, O P S EMP, Electrical Inspectors, Triangle Interests % Service Center, Cardozo Lodge, and Servco Federal Credit Unions). We reviewed the credit unions to: (1) determine the cause(s) of the credit unions’ failures and the resulting estimated $3.2 million loss to the National Credit Union Share Insurance Fund; (2) assess NCUA’s supervision of the credit unions; and (3) provide appropriate suggestions and/or recommendations to prevent future losses.