Federal Reports

During research we found the 1915(c) Community Integration and Habilitation Waiver (CIH Waiver) services that Indiana reported on the Form CMS-64 accounted for just over $1.1 billion in Medicaid expenditures during Federal fiscal years (FFYs) 2015 and 2016. These expenditures represented approximately 5.9 percent of the total Medicaid expenditures reported on the Form CMS-64 during this period. We decided to perform this audit of the CIH Waiver services because of the significant dollar expenditures. Our objective was to determine whether Indiana ensured that CIH Waiver services at 12 selected providers were provided in accordance with Federal, State, and waiver requirements.

This audit is part of a series of hospital compliance audits. Using computer matching, data mining, and data analysis techniques, we identified hospital claims that were at risk for noncompliance with Medicare billing requirements. For calendar year 2018, Medicare paid hospitals $179 billion, which represents 47 percent of all fee-for-service payments for the year.Our objective was to determine whether Lake Hospital System (the Hospital) complied with Medicare requirements for billing inpatient and outpatient services on selected types of claims.

OIG evaluated FSA's and the State of Florida's delivery of the CRBG Program.

The VA Office of Inspector General (OIG) conducted an inspection at the request of Chairman Mark Takano, House Committee on Veterans’ Affairs, to assess allegations that facility staff failed to adequately evaluate and treat Traumatic Brain Injury (TBI) for patients who served in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) at the Southeast Louisiana Health Care System in New Orleans.The OIG did not substantiate the allegations that the facility polytrauma program failed to adequately evaluate and treat TBI for patients who served in OEF/OIF/OND.The OIG reviewed data from the Veterans Health Administration (VHA) Support Service Center and found the facility screening rate generally met or exceeded VHA’s national benchmark.The OIG conducted an independent electronic health record (EHR) review to determine if patients who had a positive initial TBI screen conducted at the facility from October 1, 2017, through September 30, 2020, received a Comprehensive Traumatic Brain Injury Evaluation (CTBIE), and if the CTBIE was completed within 30 days.The OIG reviewed 327 EHRs and found 243 CTBIEs were completed, with 172 of them completed within 30 days. The OIG found scheduling challenges, primarily patient causal factors, contributed to why CTBIEs were not timely completed. Of the 243 CTBIEs completed, 181 patients were diagnosed as having a TBI.Clinical services were initiated for 162 of the 175 patients where services were indicated. The OIG found that the plans of care were thorough and found several areas in which facility staff exceeded VHA standards.The OIG did not identify adverse clinical outcomes for patients whose CTBIE was not timely completed or where clinical services were indicated but not initiated.The OIG found that facility leaders also oversaw two EHR reviews of the assessment and evaluation of facility TBI patients.The OIG made no recommendations.