Federal Reports

The objective of this review was to determine potential Medicaid program savings if the Oregon Health Authority, Division of Medical Assistance Programs (State agency), had required its Medicaid coordinated-care organization (CCO) plans to meet medical loss ratio (MLR) standards for its non-expansion population similar to those standards established by the Patient Protection and Affordable Care Act (ACA).

This is a publication by GAO's Inspector General that concerns internal GAO operations. This report was submitted to the Comptroller General in accordance with Section 5 of the Government Accountability Office Act of 2008. The report summarizes the activities of the Office of Inspector General (OIG) for the first reporting period of fiscal year 2016.

Despite $216 million in revenue from providing passport services in FY 2015, the Postal Service has been processing fewer passport applications than before. The OIG has identified three areas of customer service that could be improved with simple changes, leading to a greater number of passport applications processed. Successful passport services could establish post offices as a hub for other revenue-generating government services, such as identity verification.

The National Institute of Environmental Health Sciences (the Institute) generally administered its Superfund appropriations during fiscal year (FY) 2014 in accordance with applicable Federal requirements. However, it did not always obligate Superfund appropriations in accordance with applicable Federal laws. Specifically, the Institute improperly used $7,500 from expired Superfund appropriations. The Institute improperly used expired Superfund appropriations because it did not follow its standard operating procedure on the use of prior-year funds. By not ensuring that obligations were made within the 1-year period of availability, the Institute violated Federal appropriations law. If appropriate FY funding is not available to correct the improper obligations, an Antideficiency Act violation will have occurred.

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To determine whether the Social Security Administration (SSA) had adequate controls to ensure it establishedthe correct primary insurance amount (PIA) for widow(er)s when a wage earner died before age 62.

Some of the New York State Department of Health's (State agency) claims for Federal Medicaid reimbursement for Long-Term Home Health Care Waiver Program (LTHHCP) services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that the State agency improperly claimed at least $2.6 million in Federal Medicaid reimbursement for unallowable LTHHCP services.

Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 91 did not comply with Medicare requirements. Using our sample results, we estimated that Medicare contractors improperly paid providers in Jurisdiction H at least $1.7 million from January 1, 2012, through August 31, 2014.

DePaul Health Center (the Hospital) (operating in Bridgeton, Missouri) complied with Medicare billing requirements for 190 of the 204 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 14 claims (all of which were inpatient claims), resulting in overpayments of $81,000 for calendar years 2012 and 2013. 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.

The Ohio Association of Foodbanks (Ohio Foodbanks) assists consumers with obtaining healthcare coverage through the marketplaces and provides consumers with information about insurance affordability programs. Navigator assistance personnel (navigators) also work to raise awareness about the marketplaces and refer consumers to health insurance ombudsmen and consumer assistance programs when necessary. Ohio Foodbanks received approximately $2 million in Federal funds for the grant period ended August 14, 2014, of which $1.6 million was provided to 11 subgrantees.

While post offices sold $21 billion worth of money orders in fiscal year 2015, money order sales have plunged 60 percent from their peak in 2000.About 1,200 high volume post offices grew money order sales by at least 10 percent in the past 3 years, showing that improving sales is achievable. Selling money orders through digital channels could have significant benefits for customers, and the Postal Service could assign a strategic manager to help modernize and stabilize this important product.

The New York State Office of Children and Family Services awarded approximately $2.8 million of Disaster Relief Act funds to Bayview Nursing and Rehabilitation Center (Bayview) for construction and equipment expenses resulting from Hurricane Sandy.

The Office of Inspector General (OIG) oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor compliance with Federal grant requirements.

ARC Semi-Annual report to Congress

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.

FY 2015 LOC Financial Statements Auditor’s Report and Transmittal letter, March 2016

ARC uses other agencies such as USDA Rural Development, HUD, TVA and EPA (Basic Agency) to administer construction related projects. The Basic Agency is responsible for monitoring and reporting on project implementation. Basic Agency is used as terminology although the official terminology for use of other agencies by ARC is Child Agency

A review of FY 2015 applications, approvals and obligations confirmed that a significant amount of applications continued to be received and approvals and obligations processed in the final quarter.

The Wyoming Department of Health, Division of Healthcare Financing (State agency), did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. The State agency did not invoice manufacturers for rebates associated with $2.6 million ($1.3 million Federal share) in physician-administered drugs. Of this amount, $2.3 million ($1.2 million Federal share) was for single-source drugs, and $286,000 ($143,000 Federal share) was for top-20 multiple-source drugs. Because the State agency's internal controls did not always ensure that it invoiced manufacturers to secure rebates, the State agency improperly claimed Federal reimbursement for these single-source drugs and top-20 multiple-source drugs.