Federal Reports

Why OIG Did This AuditThe Medicare hospice benefit allows providers to claim Medicare reimbursement for hospice services provided to individuals with a life expectancy of 6 months or less who have elected hospice care. Previous OIG audits and evaluations found that Medicare inappropriately paid for hospice services that did not meet certain Medicare requirements.Our objective was to determine whether hospice services provided by Professional Healthcare at Home, LLC (Professional Healthcare), complied with Medicare requirements.How OIG Did This AuditOur audit covered 3,458 claims for which Professional Healthcare (located in Fairfield, California) received Medicare reimbursement of $20.3 million for hospice services provided from April 1, 2016, through March 31, 2018. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

An Amtrak coach cleaner based in Chicago, Illinois, was terminated from employment on June 10, 2021, following his administrative hearing. Our investigation found that the former employee violated company policy by failing to report his arrest and conviction for driving under the influence and failing to report two other criminal convictions while employed by the company.

The OIG assessed how effectively VA managed its emergency caches during the first wave of the COVID-19 pandemic in early 2020. These caches contain a standard supply of drugs and medical supplies, including some personal protective equipment, for use during a public health emergency.The review team found that use and oversight of the emergency caches were limited. Only nine of 144 medical facilities activated their emergency caches during the review period (February through June 2020). Among the reasons they were not used included medical facility directors reporting supplies were not needed or caches lacked sufficient quantity for meeting pandemic demands. The Veterans Health Administration (VHA) also changed the process for mobilizing caches during the pandemic, but without clearly communicating it to medical facility directors.The review team also identified problems with cache maintenance and monitoring. Most caches contained some expired or missing personal protective equipment, diminishing their ability to support pandemic preparedness. Expired or incomplete cache inventories can also compromise facilities’ ability to respond to other local emergencies, such as hurricanes or wildfires. Furthermore, VHA had incomplete documentation on cache activations, making it difficult to know which caches would need to be restocked. Finally, medical facility leaders were not always able to accurately report if their facility’s cache was activated during the pandemic.VHA concurred with the three OIG recommendations to (1) clarify the intended use of the emergency caches during national emergencies and develop communication and documentation requirements so that all relevant parties are aware of their responsibilities and any changes to standard activation protocols, (2) establish minimum timeframes for reordering processes to make certain the caches are stocked with unexpired inventory, and (3) implement procedures to ensure that activation records are accurate and complete.