Federal Reports

This investigation was initiated based on a hotline allegation concerning a VISTA member who may have engaged in political activities as part of his VISTA service.

This investigation was initiated based on a Hotline allegation that Ms. Meghan Olinger, former AmeriCorps Program Coordinator, Synergy, Education, and Empowerment of West Monroe (SEE), West Monroe, LA, falsely certified education awards for members who had not completed their service hours over the course of her tenure at SEE.

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage for certain low-income children, yet millions of eligible children are still uninsured. To increase enrollment of eligible children, Congress authorized States to adopt the Express Lane Eligibility (ELE) option, which allows States to expedite and simplify enrollment in Medicaid and CHIP by relying on findings from other agencies' eligibility determinations. Congress will determine whether to reauthorize the ELE option in 2017. We conducted this study in response to a Congressional request that the U.S. Department of Health and Human Services, Office of Inspector General (OIG) examine the benefits and barriers to State use and expansion of ELE. This report is being issued concurrently with two OIG audits that fulfill a Congressional mandate to assess whether State agencies met Federal requirements in making eligibility determinations using ELE and developing eligibility error rates.

The Reports Consolidation Act of 2000 requires the U.S. Department of Education (Department) Office of Inspector General to identify and report annually on the most serious management challenges the Department faces. The Government Performance and Results Modernization Act of 2010 requires the Department to include in its agency performance plan information on its planned actions, including performance goals, indicators, and milestones, to address these challenges. To identify management challenges, we routinely examine past audit, inspection, and investigative work, as well as issued reports where corrective actions have yet to be taken; assess ongoing audit, inspection, and investigative work to identify significant vulnerabilities; and analyze new programs and activities that could post significant challenges because of their breadth and complexity. Last year, we presented five management challenges: improper payments, information technology security, oversight and monitoring, data quality and reporting, and information technology system development and implementation. While the Department remains committed to addressing these areas and has taken or plans action to correct many of their underlying causes, each remains as a management challenge for fiscal year 2017.

States generally determined Medicaid eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State Medicaid agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into Medicaid. From our sample of 157 beneficiaries, States correctly determined eligibility for 133 beneficiaries. We found no errors in 6 of the 10 States reviewed; however, 4 States did not determine eligibility for 17 beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 731,365 beneficiaries were eligible, but 86,672 were potentially ineligible. We also estimated that Federal and State Medicaid payments on behalf of eligible beneficiaries totaled $1.5 billion, and Federal and State Medicaid payments made on behalf of potentially ineligible beneficiaries totaled $284.1 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

States generally determined Children's Health Insurance Program (CHIP) eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State CHIP agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to facilitate enrollment into CHIP. From our sample of 120 beneficiaries, States correctly determined eligibility for 110 beneficiaries. We found no eligibility errors in four of the eight States reviewed; however, four States did not determine eligibility for seven beneficiaries in accordance with Federal requirements. On the basis of our sample, we estimated that 148,375 beneficiaries were eligible, but 6,998 were potentially ineligible. We also estimated that Federal and State CHIP payments on behalf of eligible beneficiaries totaled $196.9 million, and Federal and State CHIP payments made on behalf of potentially ineligible beneficiaries totaled $10.6 million. We attribute the enrollment of potentially ineligible beneficiaries to State-specific eligibility determination errors.

The OIG identified strengths within the Generation Construction (GC) Projects organization related to (1) organizational alignment, (2) collaboration within GC departments, (3) management support of employees, and (4) employee engagement. However, we also identified inherent project management risks that, coupled with relationship issues between GC personnel and customer and support organizations, could increase the risk that GC will not be able to effectively meet its mission in the future. Specifically, both GC personnel and customer and support organizations mentioned lack of recognition of how each organization affects the other, lack of knowledge of TVA Standard Programs and Processes, lack of collaboration and communication, and conflicting priorities as issues that affect their relationships.

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Quarterly Summary Memorandum for the Lead Inspector General, Department of Defense

More Americans like the concept of drone delivery than dislike it, but a large number have yet to decide. Drone malfunction is the public's primary concern — far more than fears about intentional misuse. Exposure to information about drone delivery correlates with greater interest in the idea. The American public anticipates that drone delivery will be offered within the next 5 to 10 years.

We conducted this study and its companion, Indian Health Service Hospitals: More Monitoring Needed to Ensure Quality Care (OEI-06-14-00010), in response to concerns about the care provided in IHS hospitals. Reports of inadequate health care services for American Indians and Alaska Natives (AI/ANs) have concerned the Federal Government for almost a century. IHS is responsible for providing health services to the 567 federally recognized tribes of AI/ANs. As part of its service, IHS directly operates 28 acute-care hospitals. IHS requires its hospitals to be accredited by a nationally recognized organization (or Medicare-certified) and to comply with the Medicare Hospital Conditions of Participation (CoPs). OIG is committed to continued work to improve patient care provided in IHS hospitals.

The North Carolina Division of Medical Assistance (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. The State agency used statistically invalid random moment sampling (RMS) in allocating costs to Medicaid, and it did not maintain adequate support to validate its sample results and related extrapolations. In addition, it claimed these costs without promptly submitting to the U.S. Department of Health and Human Services, Division of Cost Allocation (DCA), for review its cost allocation plan (CAP) amendment describing its new random moment timestudy (RMTS) methodology. Instead, the State agency claimed costs based on an implementation plan describing the new RMTS methodology, which was conditionally approved by CMS. As a result, the almost $107.5 million (almost $53.8 million Federal financial participation) the State agency claimed in school-based Medicaid administrative costs for Federal fiscal years 2010 through 2012 was unallowable.

Both the Centers for Medicare & Medicaid Services' (CMS) policies and procedures to ensure that payments are not made for Medicare services rendered to incarcerated beneficiaries and its planned revisions to those policies and procedures did not comply with Medicare requirements.

CMS had policies and procedures to ensure that payments were not made for Medicare services ostensibly rendered to deceased individuals. These policies and procedures generally ensured that CMS did not make improper payments when its data systems indicated at the time a claim was processed that the individual had died before the claimed date of service. These policies and procedures also ensured that CMS correctly identified and recouped improper payments for almost all of the cases in which the Enrollment Database (EDB) was updated with date-of-death information after the claims had been processed and paid.

We conducted this study and its companion, Indian Health Service Hospitals: Longstanding Challenges Warrant Focused Attention to Support Quality Care (OEI 06 14 00011), in response to concerns about the care provided in IHS hospitals. Reports of inadequate health care services for American Indians and Alaska Natives (AI/ANs) have concerned the Federal Government for almost a century. IHS is responsible for providing health services to the 567 federally recognized tribes of AI/ANs. As part of its service, IHS directly operates 28 acute-care hospitals. IHS requires its hospitals to be accredited by a nationally recognized organization (or certified by Medicare) and to comply with the Medicare Hospital Conditions of Participation (CoPs). OIG is committed to continued work to improve patient care provided in IHS hospitals. Upcoming OIG work includes an IHS management review and a medical review focusing on patient safety in IHS hospitals.

As part of our annual audit plan, the OIG audited costs billed to the Tennessee Valley Authority (TVA) by CSX Transportation, Inc. (CSXT) for the transportation of coal from various coal mines and blending facilities to the Bull Run Fossil Plant (BRF) under contract numbers 65133, 14474, 86072, 85702, and 85770. Our audit included approximately $41.5 million in costs CSXT billed to TVA from October 1, 2014, to March 31, 2016, under these five contracts. Our objective was to determine if the costs billed to TVA by CSXT were in compliance with the contracts' terms and conditions. In summary, we determined CSXT overbilled TVA $8,045,846 for costs billed under contract numbers 65133 and 85702. The overbilling included (1) $8,040,045 for overstated adjustments of per-ton rates under contract number 65133 dating back to January1, 2007, and (2) $5,801 for overstated fuel price adjustments under contract number 85702.(Summary Only)

The OIG audited TVA's compliance with the North American Electric Reliability Corporation's (NERC) Critical Infrastructure Protection (CIP) standards for logical and physical access for systems and locations that are considered high risk assets under NERC CIP standards. We found TVA was within the NERC CIP compliance standards for logical and physical access to high risk systems and locations with minor exceptions that were addressed during the audit. In addition, during our testing, we noted discrepancies between initial clearance dates in the hard copy and electronic records that were addressed during the audit.(Summary Only)

Transmittal of the Final Report, Opportunities Exist to Accelerate Maturation of the FTC’s Information Technology Governance Practices

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The Colorado Department of Health Care Policy and Financing (HCPF) had not implemented adequate information system general controls over the Colorado Medicaid eligibility determination and claims processing systems to fully comply with Federal requirements. The vulnerabilities that we identified increased the risk to the confidentiality, integrity, and availability of Colorado's Medicaid data. In evaluating HCPF's risk assessment, database security, Web site security, and universal serial bus (USB) device security for its Medicaid eligibility determination and claims processing information systems, we identified vulnerabilities related to inadequate risk assessment policies and procedures, improper administration of the Medicaid claims database, inadequate security of Medicaid databases, inadequate Web site security, and improper management of USB ports and devices.

Noridian Healthcare Solutions, LLC, a subsidiary of Noridian Mutual Insurance Company, did not claim $144,000 of allowable pension or postretirement benefit plan costs for Medicare reimbursement during fiscal years 2006 through 2008.

Bergan Mercy Medical Center (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 219 of the 224 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining five claims, resulting in overpayments of $70,000 for calendar years 2013 and 2014. Specifically, three outpatient claims had billing errors, resulting in overpayments of $63,000, and two inpatient claims had billing errors, resulting in overpayments of $7,000. 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.

This document discusses EAC OIG’s planned oversight activities for fiscal year 2017.

As required by The Inspector General Act of 1978 (as amended), this Semiannual Report summarizes the activities of the Department of Transportation Office of Inspector General for the stated 6-month period.