Federal Reports

Health Research, Inc., appropriately budgeted and claimed allowable Hurricane Sandy Disaster Relief Act funding. Accordingly, this report does not contain recommendations.

Promise Hospital of Ascension (The Hospital), in Gonzales, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 62 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no malnutrition at all. For four of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the diagnosis-related group or payment amount. However, for the remaining 58 inpatient claims, the errors resulted in overpayments of $465,000. The Hospital believes that all claims that we identified were appropriately submitted for payment.

Medicare paid 10 of 143 selected inpatient claims for bone marrow and stem cell transplant procedures in accordance with Medicare requirements. However, 133 claims did not comply with those requirements. For 120 of these claims, the hospitals incorrectly billed Medicare Part A for beneficiary stays that should have been billed as outpatient or outpatient with observation services. These claims did not have clinical evidence supporting that an inpatient level of care was required before, during, or after the transplant procedures were performed. For the remaining 13 claims, the hospitals billed incorrect Medicare Severity Diagnosis-Related Groups (MS DRGs). As a result of the 133 errors, Medicare overpaid the hospitals by $6.3 million. Medicare overpaid the hospitals because existing controls were not effective in preventing the overpayments.

Charge Card

Annual report to OMB on the Government charge card.

The allocable postretirement benefit costs used by CIGNA Government Services, LLC, during calendar years 2007 through 2011 were reasonable and allowable.

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Mortgage servicers have wrongfully terminated homeowners out of the HAMP program

The effectiveness of the CSB’s information security program is challenged by its lack of personal identity verification cards for logical access, complete system inventory, and documented policies and procedures for specialized security training.

SIGTARP's Quarterly Report to Congress

The OIG audited costs billed to the Tennessee Valley Authority (TVA) by URS Energy and Construction, Inc. (URS), under contract numbers 66777 and 72142. The audit included approximately $113.6 million in costs URS billed to TVA from January 1, 2012, to November 26, 2013.The OIG determined URS may have overbilled TVA $6,885,835 in shared cost savings and $317,852 for a completion bonus, due to potential misrepresentations in estimated material costs included in the Target Cost Estimate for the John Sevier Combined Cycle project. In addition, we determined URS overbilled TVA $1,205,758, including: (1) $378,212 in overbilled temporary assignment costs, (2) $325,876 in other direct costs, (3) $439,189 in labor costs, (4) $55,390 in markup costs, and (5) $7,091 in travel costs. URS issued credits and refunds to TVA during the course of our audit, which reduced the amount to be recovered by $76,745.(Summary Only)

University of Minnesota Medical Center (the Hospital) complied with Medicare billing requirements for 125 of the 255 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 130 claims, resulting in overpayments of $565,000 for CYs 2012 and 2013 (audit period). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $3.3 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.

Hidalgo Medical Services (HMS), in Lordsburg, New Mexico, did not comply with all applicable Federal requirements and grant terms related to its Patient Protection and Affordable Care Act-funded capital development grant.

We noted that the Massachusetts Department of Elementary and Secondary Education’s oversight of LEA single audit resolution was notsufficient to ensure that LEAs took timely and appropriate corrective action. We found that in many cases the Massachusetts Department of Elementary and Secondary Education did not identify and require appropriate corrective actions for LEAs to take to adequately resolve their findings. Additionally, the Massachusetts Department of Elementary and Secondary Education did not have a tracking process for individual LEA findings and did not follow up on the status of corrective actions for many of the repeat findings covered by our review. We also noted that the Massachusetts Department of Elementary and Secondary Education generally did not communicate effectively with LEA officials regardingaudit resolution, and none of the Massachusetts Department of Elementary and Secondary Education’s management decision letters that were reviewed met all Federal requirements for content.

Total Renal Laboratories, Inc. (TRL), did not always comply with Medicare requirements for tests billed with an AY modifier for beneficiaries with end-stage renal disease (ESRD). Specifically, for 60 of the 100 beneficiary-days, TRL submitted separate claims using the AY modifier for tests furnished for the treatment of ESRD contrary to the consolidated billing requirement. In addition, TRL did not always comply with other Medicare requirements. These errors occurred primarily because TRL did not have adequate controls to comply with certain Medicare requirements. On the basis of our sample results, we estimated that Medicare overpaid TRL at least $1.2 million for tests that were furnished for the treatment of ESRD.

DVA Laboratory Services, Inc. (DVA), did not always comply with Medicare requirements for tests billed with an AY modifier for beneficiaries with end-stage renal disease (ESRD). Specifically, for 62 of the 100 beneficiary-days, DVA submitted separate claims using the AY modifier for tests furnished for the treatment of ESRD contrary to the consolidated billing requirement. In addition, DVA did not always comply with other Medicare requirements. These errors occurred primarily because DVA did not have adequate controls to comply with certain Medicare requirements. On the basis of our sample results, we estimated that Medicare overpaid DVA at least $989,000 for tests that were furnished for the treatment of ESRD.