Federal Reports

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (State agency), did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents to the Department of Developmental Services (DDS), (2) DDS obtained and analyzed data on all critical incidents, (3) appropriate action steps were identified in all incident reports that could prevent similar critical incidents, and (4) DDS always reported all reasonable suspicions of abuse or neglect to the Disabled Persons Protection Commission (DPPC).

The Alabama Medicaid Agency (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. It claimed these costs without submitting for Division of Cost Allocation review its public assistance cost allocation plan (CAP) and certain amendments and, consequently, without having an approved CAP. Instead, the State agency claimed costs based on various versions of its implementation guides and plans that were being considered by and negotiated with CMS. In addition, 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. As a result, the almost $150.5 million (almost $75.3 million Federal Financial Participation) the State agency claimed in school-based Medicaid administrative costs for FFYs 2010 through 2012 was unallowable. The State agency attributed its lack of compliance with Federal requirements regarding submission of the CAP to staff turnover and a lack of knowledge of Federal requirements.

The Alabama Medicaid Agency (State agency) did not comply with Federal and State requirements for claiming $209.5 million ($162.5 million Federal share) in certified public expenditures (CPEs) for Federal fiscal year 2010. The State agency incorrectly claimed $27.5 million ($21.3 million Federal share) because it made errors in its CPE calculation.

This report provides a summary of our investigative findings in cases involving administrative misconduct.

The Child Care and Development Fund (CCDF) block grant program is a Federal-State partnership to provide eligible, low income families with help paying for child care at a provider of their choice. Within the CCDF program, OIG has previously identified fraud, found improper payments, and exposed health and safety concerns at child care facilities. In addition, CCDF has been identified as a Federal program that is susceptible to significant improper payments, with an estimated $311 million in improper payments identified for fiscal year (FY) 2015. This report focuses on how States and the Administration for Children and Families (ACF) ensure the integrity of the CCDF block grant program and the results of States' program integrity activities. This work is part of an initiative that OIG is undertaking to address vulnerabilities in grant programs across the Department of Health and Human Services.

We identified internal control weaknesses in the system that increase the risk that Virginia will be unable to prevent or detect unauthorized access and disclosure of personally identifiable information. Specifically, we found that although Virginia classified the Single Sign-on Web System as a sensitive system, it did not ensure that it met the minimum State requirements for a system classified as sensitive. This meant thatVirginia also was not in compliance with the Statewide Longitudinal Data Systems grant requirements. We determined that Virginia has policies and procedures that address reporting and responding to unauthorized access and disclosure of data, but we could not determine whether Virginia effectively implemented the procedures because Virginia has not reported any system breaches in the Virginia Longitudinal Data System or the Single Sign-on Web System.

Houston Methodist Hospital (the Hospital) located in Houston, Texas, complied with Medicare billing requirements for 111 of the 159 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 48 claims, resulting in net overpayments of $609,000 for the audit period. Additionally, the Hospital did not fully comply with Medicare billing requirements for three of the five separate inpatient claims we reviewed, resulting in overpayments of $68,000. On the basis of our sample results, we estimated that the Hospital received approximately $1.3 million in overpayments from Medicare.

This Newsletter provides a bimonthly summary of selected investigative accomplishments.

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The OIG audited costs billed to the Tennessee Valley Authority (TVA) by ABB, Inc. (ABB), for providing large and medium power transformers under Contract No. 4645. Our audit included $83.3 million in costs paid by TVA between June 1, 2011, and March 31, 2015. Our objective was to determine if the costs billed to TVA were in compliance with the contract terms and conditions. In summary, we determined TVA missed payment discount opportunities of $1,029,965, including (1) $936,596 due to incorrect payment terms input into the Maximo system on purchase orders (PO) for which TVA opted to make progress payments, and (2) $93,369 for POs for which TVA opted not to make progress payments. Also, ABB overbilled TVA $155,577 for transformer and other costs, and TVA is due a $188,000 rebate for a transformer that had been purchased. In addition, we noted several opportunities to improve contract administration by TVA. Specifically, we found (1) ABB billed TVA $10,293,437 for materials, equipment, and services not provided for under the contract scope of work; (2) TVA payments exceeded the contract monetary limits; (3) ABB billed TVA $506,592 for instrument transformer purchases that should have been ordered and paid for under a different contract TVA had with ABB; and (4) ABB had not provided the price adjustment formulas for each transformer design type required by the contract. TVA management (1) changed the contract payment terms in the Maximo system on March 21, 2014, from Net 45 days to 2 percent-16 days/Net 45 days, which corrected the problem of missed payment discount opportunities when TVA had opted to make progress payments, and (2) issued Contract Amendment No. 4, effective July 28, 2015, which partially addressed the contract scope of work and fully addressed the price adjustment formulas. However, the contract scope of work needs to be further amended to include materials and services.(Summary Only)

Cornerstone Hospital of Southwest Louisiana (the Hospital) in Sulphur, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 52 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. The 52 inpatient claims that were coded incorrectly resulted in overpayments of $343,000. Hospital officials believe that all claims identified by OIG were appropriately submitted for payment.

This Grant was provided for the grantee to provide support for the Partnership for Regional Economic Performance (PREP) program which is designed to provide for economic development in West Central PA

This report details the results of our review of the National Oceanic and Atmospheric Administration’s (NOAA’s) sole-source contract award to Industrial Economics, Incorporated. On April 20, 2010, an explosion on the British Petroleum (BP) Deepwater Horizon oil well drilling platform released approximately 4.9 million barrels (210 million gallons) of oil into the Gulf of Mexico. Our objective was to determine whether NOAA properly documented the justification of awarding a September 2011 sole-source contract with Industrial Economics, Incorporated.

We conducted this audit to examine BIS’ progress in transitioning to USXPORTS. We began this audit with two objectives: to determine whether BIS was (1) effectively and efficiently managing its transition toward using USXPORTS to perform export licensing processing and (2) using effective and efficient software development practices for CUESS. However, during our fieldwork, we decided to forgo analysis on the second objective, as CUESS is currently in production with no plan for major development work on the system.

The New Jersey Department of Human Services (State agency) did not adequately oversee its Medicaid nonemergency medical transportation brokerage program to ensure that (1) vehicles used to transport beneficiaries met State standards, (2) drivers were licensed and qualified, (3) prior authorizations were obtained, (4) transportation providers maintained required insurance coverages, (5) beneficiaries received Medicaid-eligible medical services on the date of transportation, and (6) services were documented.

Christian Hospital (the Hospital) (operating in Saint Louis, Missouri) complied with Medicare billing requirements for 95 of the 199 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 104 claims, resulting in overpayments of $341,000 for calendar years 2012 and 2013. Specifically, 89 outpatient claims had billing errors, resulting in overpayments of almost $280,000, and 15 inpatient claims had billing errors, resulting in net overpayments of almost $62,000. 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 grant provided the majority of the approved budget was for staff salaries, benefits and indirect costs.

This is a publication by GAO's Inspector General that concerns internal GAO operations. This report addresses the extent to which GAO has established an effective framework of controls to guide its contract management process.

Open World Leadership Center Financial Statement Audit - Auditor’s Report and Transmittal letter, July 2016

We found that the Department’s audit followup process was not always effective and noted that the Department’s accountable office did not fulfill its responsibilities to (1) ensure that action officials had systems in place to follow up on corrective actions, (2) monitor compliance with OMB Circular A-50, and (3) ensure the overall effectiveness of the audit resolution and followup system. We also found that the Department did not ensure timely audit closure and principal offices did not always adequately maintain documentation of audit followup activities. As a result, the Department did not have assurance that requested corrective actions were taken and that the issues noted in the OIG audits were corrected.

The University of Tennessee Medical Center (the Hospital) complied with Medicare billing requirements for 219 of the 236 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 17 claims, resulting in overpayments of $42,000. These overpayments occurred primarily because the Hospital did not have adequate controls to prevent incorrect billing of Medicare claims within the selected risk areas that contained errors.

A Florida physical therapy practice (the Therapy Practice), located in Boca Raton, Florida, properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days that we sampled. However, the Therapy Practice improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days. These deficiencies occurred because the Therapy Practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements.

The Office of Inspector General (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. The reviews assess the Units' adherence to the 12 MFCU performance standards and its compliance with applicable Federal statutes and regulations.

We found that FSA does not have sufficient oversight of IT projects to provide assurance that its Lifecycle Management Methodology process is appropriately implemented. FSA does not have an accountability mechanism and, as a result, it did not always conduct required technical and management reviews in accordance with the Lifecycle Management Methodology criteria and did not always update project tailoring plans asprojects progressed through their lifecycle. In addition, we found that FSA did not maintain a complete and reliable inventory of IT projects and did not track the progress of all IT projects in its Enterprise Project Portfolio Management system. We concluded that FSA’s lack of an accountability mechanism increased the likelihood of unnecessary risk and costly delays.

CNCS management reported a Foster Grandparent Program (FGP) volunteer was arrested by Tooele Police Department, Tooele, UT, on allegations of sexual assault of a minor, while serving at a FGP school site.

This report fulfills the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA) for 2016. The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans (i.e., stand-alone prescription drug plans and Medicare Advantage prescription drug plans) include drugs commonly used by full benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the sixth report the OIG has produced to meet this mandate.

This report provides the results of our most recent audit to evaluate the First Responder Network Authority’s (FirstNet’s) process for managing interagency agreements (IAAs), including entering into, monitoring, and closing IAAs.

The National Credit Union Administration Office of Inspector General conducted this review as required by the Government Charge Card Abuse Prevention Act of 2012. Specifically, we conducted a risk assessment of NCUA’s individually billed accounts travel card program and centrally billed accounts travel and purchase card programs. In addition, because NCUA exceeded the Act’s $10 million threshold, we conducted a limited-scope audit of NCUA’s individually billed account travel card program.

The President's Emergency Plan for AIDS Relief (PEPFAR) was authorized to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Additional funds were authorized to be appropriated through 2018.

Seek link below for the full report, report summary, multimedia or any agency follow-up.

Seek link below for the full report, report summary, multimedia or any agency follow-up.

In 2008, the Tennessee Valley Authority's (TVA) Office of the Inspector General (OIG) performed an audit (2007-11348, Information Services Organizational Effectiveness, March 27, 2008) on the effectiveness of the Information Technology (IT) organization and made several recommendations for improvements. In 2011, TVA OIG completed a follow-up audit (2010-13366, Information Technology Organizational Effectiveness, April 5, 2011) and determined the actions taken were not carried through year to year, and as a result, effectiveness in many areas decreased. Accordingly, recommendations in that audit report were focused on creating sustainable processes. In addition, TVA's former Chief Information Officer created a program titled 1,000 Days to Success (IT1K) to address findings from the 2011 audit as well as other observations he made as to the current state of IT.In December 2013, IT informed the OIG that management action plans to address recommendations from the 2011 audit were complete. Soon thereafter, IT informed us it had also completed implementation of the IT1K program. To assess the results of the management action plans, the IT1K program, and to determine the current state of IT's organizational effectiveness, a follow-up IT organizational effectiveness audit was scheduled. The objective of this audit was to evaluate the effectiveness of organizations within IT in meeting TVA's mission and values. To accomplish this, we evaluated (1) current effectiveness of operational groups within IT, (2) IT's alignment with TVA values, (3) the outcomes of IT1K initiatives, and (4) the outcomes of management action.We found operational maturity levels were generally trending upward; however, actions are needed to improve alignment with TVA values in two IT groups, and some IT1K initiatives and management action plans have not been completed or sustained. In addition, we found IT could make improvements in three areas that were not previously covered in our audits of the individual groups under IT-(1) progression planning, (2) support for critical applications, and (3) job descriptions.(Summary Only)