Federal Reports

Naples Community Hospital (the Hospital), located in Naples, Florida, complied with Medicare billing requirements for 134 of the 225 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 91 claims, resulting in net overpayments totaling $409,000. 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 at least $4.5 million in overpayments from Medicare.

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ARC grant (referred to as PREP grant) is a continuing, annual grant awarded to support NTRPDC's Enterprise Development Program that serves businesses and communities through four major work elements: small business financing; export development; procurement technical assistance; and e-commerce development.

The Wisconsin Department of Health Services (State agency) improperly claimed at least $74,000 in enhanced Federal Medicaid reimbursement for non-family-planning services for the period October 1, 2010, through September 30, 2012.

This is a publication by GAO's Inspector General that concerns internal GAO operations. The report summarizes the activities of the Office of Inspector General (OIG) for the second reporting period of fiscal year 2015.

A board of directors comprised of the County Commissioners from the five member counties and six private sector representatives oversee the programs, operations and administrative of NTRPDC.

Our audit of the Census Bureau’s regional office alignment and field management reforms included two objectives: (1) identify and assess the benchmarks—including the manner in which response rates are calculated and reported on surveys such as the American Community Survey—that the Bureau is using to assess the success of the realignment effort and assess whether or not the Bureau is achieving its cost savings and efficiency goals; and (2) assess the impact of the realignment on survey sponsors and customers and determine whether external sponsoring agencies and internal Census Bureau offices are satisfied with the survey content and design process, survey administration, data quality, cost, and any other issues deemed important.

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Attention to U.S. Chemical Safety and Hazard Investigation Board (CSB) management challenges could result in stronger results and protection for the public, and increased confidence in management integrity and accountability.

Inspector General Identified Managment Challenges

OMB Circular A-136, Financial Reporting Requirements, requires that the Inspector General provide the agency head with a summary of the top management and performance challenges facing the agency. After careful analysis, it is our assessment that the areas of financial management, human capital, information technology, and grantee accountability represent the top management and performance challenges for NEA.

The Patient Protection and Affordable Care Act (ACA) established standards for the amount of premium revenue that certain commercial health insurers and Medicare Advantage plans can spend on costs other than healthcare-related expenses. These standards are known as the medical loss ratio (MLR). Insurers that do not meet these standards must pay rebates to their enrollees or the Department of Health and Human Services. Although the MLR standards do not apply to Medicaid spending, some States have applied similar standards to their contracts with Medicaid managed care organizations. The Federal Government is entitled to the Federal share of the net amount recovered by a State with respect to its Medicaid program.

Boca Raton Regional Hospital, Inc. (the Hospital), located in Florida, complied with Medicare billing requirements for 161 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 50 claims, resulting in overpayments of $514,000 for the audit period. The outpatient claims selected for review did not contain errors. 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 at least $2.6 million in overpayments from Medicare.

The Office of Inspector General released a report examining NASA's education program and its efforts to promote science, technology, engineering, and mathematics (STEM) careers.

CNCS management reported that a CNCS employee may have submitted fraudulent timesheets when she claimed hours not worked. CNCS management terminated the employee and sought $772.96 for hours not worked.

This is a summary of the complete audit report. The Inspector General has determined publically releasing the complete audit report would unacceptably increase the risk to the agency’s information technology systems by disclosing too much information on persistent security deficiencies.

Kindred Hospital of Central Ohio (the Hospital), in Mansfield, Ohio, did not comply with Medicare requirements for billing Kwashiorkor on any of the 77 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 66 of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. For the remaining 11 inpatient claims, the errors resulted in overpayments of $62,000. Hospital officials attributed these errors to a former owner of the hospital and to a lack of clarity in the coding guidelines.

For our final report on the Bureau of Industry and Security's (BIS') continuous monitoring program, our objective -- in accordance with the Federal Information SecurityManagement Act of 2002 -- was to determine whether BIS' continuous monitoring strategy and practices, including ongoing security control assessments of its critical information systems, provide adequate information for authorizing officials to make proper risk-based decisions.

FY 2015 FTC Management Challenges

Wisconsin's Federal Medicaid withdrawals during FYs 2010 through 2012 did not fully comply with Federal and State regulations. The Wisconsin Department of Health Services (State agency) properly withdrew $13.6 billion of the $13.7 billion obtained in Federal Medicaid funds. However, the State agency inappropriately withdrew the difference of $89.6 million to pay for aggregate annual projected costs. According to the approved State waivers, these costs should have been paid for solely with State funds for the first 3 months of each calendar year during FYs 2010 through 2012.

Most Medicaid payments that the Oklahoma Health Care Authority made to providers for full vials of Herceptin from January 1, 2012, through December 31, 2014, were correct. Of the 85 claim lines reviewed, 82 were correct and 3 were incorrect.

Top management challenges report.

Total Sleep Management, Inc. (Total Sleep), an Independent Diagnostic Testing Facility, based in Orlando, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries, Total Sleep billed Medicare claims for polysomnography services that met Medicare billing requirements for 21 beneficiaries with 38 corresponding lines of service. However, Total Sleep billed Medicare claims for the remaining 79 beneficiaries with 111 corresponding lines of service that did not meet Medicare requirements, resulting in overpayments totaling $51,000.

The internal controls of the Kentucky Health Benefit Exchange (Kentucky marketplace) were generally effective in ensuring that individuals were enrolled in qualified health plans (QHPs) according to Federal requirements. However, we identified deficiencies with maintenance of identity-proofing documentation, verification of eligibility for minimum essential coverage, and resolution of inconsistencies in eligibility data. QHPs are private health insurance plans that each marketplace recognizes and certifies as meeting certain participation standards and covering a core set of benefits.

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This report includes EAC OIG’s independent assessment of the top management challenges facing EAC in fiscal year 2016.

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 2016.

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3D printing continues to disrupt global supply chains, shifting long-distance transportation to last-mile shipping. Delivery and logistics companies around the world are taking notice of these changes and beginning to offer 3D printing services.

Altru Hospital (the Hospital) (operating in Grand Forks, North Dakota) complied with Medicare billing requirements for 241 of the 253 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 12 claims, resulting in overpayments of $66,000. Specifically, nine outpatient claims had billing errors, resulting in overpayments of $39,000, and three inpatient claims had billing errors, resulting in 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.

For our audit of National Institute of Standards and Technology (NIST) Office of Acquisition and Agreements Management’s (OAAM’s) management, monitoring, and administration of NIST firm-fixed-price (FFP) contracts during FYs 2011–2013, our objectives were to determine whether (1) NIST OAAM has managed, monitored, and administered the FFP contracts in accordance with federal and Departmental requirements; (2) contract officer’s representative (COR) requirements were met and completed in accordance with federal and Departmental requirements; and (3) all invoice payments were valid, reasonable, and paid on a timely basis in accordance with federal and Departmental requirements.