Federal Reports

University of Mississippi Medical Center (the Hospital) (operating in Jackson, Mississippi) complied with Medicare billing requirements for 137 of the 217 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 80 claims, resulting in net overpayments of $68,000 for the audit period. Specifically, 12 inpatient claims had billing errors, resulting in net overpayments of $41,000 and 68 outpatient claims had billing errors, resulting in net overpayments of $27,000. 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 net overpayments of at least $356,000 for the audit period.

NorthShore University HealthSystem (the Hospital) complied with Medicare billing requirements for 97 of the 190 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 93 claims, resulting in overpayments of $625,000 for CYs 2013 and 2014 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $4.1 million for the audit period. Overpayments 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.

South Carolina's Medicaid managed care program would not have saved any Medicaid funds in calendar year (CY) 2014 if the State agency had (1) required its Medicaid managed care plans to meet the minimum medical loss ratio (MLR) standard similar to the Federal standards for certain private health insurers and Medicare Advantage plans and (2) required remittances when Medicaid managed care plans did not meet the MLR standard. Specifically, all of the six managed care plans that we reviewed had MLRs greater than 85 percent (the minimum MLR standard for large private insurers) during CY 2014.

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This is a publication by GAO's Inspector General that concerns internal GAO operations. This report is the first in a series of Office of Inspector General's (OIG) reports that will review GAO's implementation of the DATA Act. It assesses whether GAO's efforts and readiness to report financial and payment data were consistent with the DATA Act's implementation guidance and requirements. Given the current stage of GAO's DATA Act implementation efforts, we limited our assessment to the first four of the eight steps in the Department of the Treasury's (Treasury) DATA Act Implementation Playbook.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted clinician payment reforms designed to put increased focus on the quality and value of care. These reforms, known as the Quality Payment Program (QPP), are a significant shift in how Medicare calculates compensation for clinicians and require CMS to develop a complex system for measuring, reporting, and scoring the value and quality of care. CMS issued final regulations on October 14, 2016, and the first performance year will begin January 1, 2017, with the first payment adjustments taking effect on January 1, 2019. Clinicians may participate in one of two QPP tracks: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (Advanced APMs).

Section 11(d)(9) of the Inspector General Act of 1978, as amended, requires the Council of the Inspectors General on Integrity and Efficiency to submit to Congress and the President an annual report on the activities of the Integrity Committee. For more informatoin about the Integrity Committee, please visit the link below.

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The Tennessee Valley Authority (TVA) vendor management system is a cloud based system physically located away from TVA facilities and outsourced to a third party. The OIG audited the vendor management system to assess the (1) data processing and application controls to ensure data integrity and reliability and (2) logical security controls to ensure only authorized access to system resources and protection of sensitive information. Our scope included TVA's vendor management system and its interfaces to TVA systems. We found TVA system interfaces associated with the vendor management system had reasonable data processing and application controls to ensure data integrity and reliability. However, we found weaknesses in the logical security controls that increase the risk of unauthorized access to TVA data. TVA and the third party responsible for the vendor management system agreed with our findings and recommendations.(Summary Only)

The North Mississippi Medical Center (the Hospital) (operating in Tupelo, Mississippi) complied with Medicare billing requirements for 158 of the 237 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 79 claims, resulting in overpayments of $41,000 for the audit period. Specifically, 4 inpatient claims had billing errors, resulting in overpayments of $12,000, and 75 outpatient claims had billing errors, resulting in overpayments of $29,000. 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 $119,000 for the audit period.

CMS implemented the "2-midnight" policy in fiscal year (FY) 2014. The policy establishes that inpatient payment is generally appropriate if physicians expect beneficiaries' care to last at least 2-midnights; otherwise, outpatient payment would generally be appropriate. CMS implemented the 2-midnight policy to address three vulnerabilities in hospitals' use of inpatient and outpatient stays: improper payments for short inpatient stays; adverse consequences for beneficiaries of long outpatient stays, including that they may not have the 3 inpatient nights needed to qualify for skilled nursing facility (SNF) services; and inconsistent use of inpatient and outpatient stays among hospitals. This report follows up on previous OIG work and compares data from the year before and the year after the implementation of the 2-midnight policy.

As the second in a series of debt collection audits, this report addresses the extent to which GAO has established effective controls to prevent or detect reservist differential errors and overpayments and collect any resulting debt.

Abbott Northwestern Hospital (the Hospital) complied with Medicare billing requirements for 88 of the 162 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 74 claims, resulting in overpayments of $934,000 for 2013 and 2014 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments of at least $8 million for the audit period. Overpayments 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.

Audit Report

CNCS management alerted CNCS-OIG of an allegation concerning Prohibited Abortion Activity directed by an AmeriCorps grantee employee with the International Institute of Metropolitan St. Louis (IISTL), St Louis, MO.

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess the Unit's adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.

Annual review of electronic backpay disbursements to identify fraudulent backpay disbursements.

Financial Statement

At the request of the Tennessee Valley Authority (TVA) Supply Chain, the OIG examined the cost proposal submitted by a company for construction services for TVA bottom ash dewatering facilities. Our objective was to determine if this company's cost proposal was fairly stated for a planned $100 million contract. In our opinion, the company's cost proposal was overstated. Specifically, the company's cost proposal for the Kingston Fossil Plant (KIF) baseline project included overstated fees and costs. We estimated TVA could avoid about $4.5 million on the $100 million contract by (1) negotiating reductions to the proposed fee rate and only applying fee to costs specified in TVA's request for proposal, and (2) revising the KIF baseline project estimated costs to eliminate unsupported engineering costs and reflect the correct markup rates. Additionally, we found the company's cost proposal included incorrect craft labor rates.(Summary Only)

At the request of United States Capitol Police (USCP or the Department) Oversight Committees and in accordance with our annual plan, the Office of Inspector General (OIG) evaluated the Department's disciplinary process. Our primary objectives were to determine if the Department (1) established internal controls and processes for ensuring that USCP employees subject to the disciplinary process were afforded due process based on transparency and fairness, and (2) complied with applicable policies and procedures as well as applicable laws, regulations, and best practices. Our scope included internal controls, processes, and operations during Fiscal Year (FY) 2014 and FY 2015. 

CNCS-OIG completed its investigation into hotline allegations that VISTA members (VISTA) assigned to Programa de Apoyo y Enlace Comunitaro (PAEC), Rincon, PR, were directed to perform duties ordinarily performed by a paid employee.

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