Federal Reports

The Hospital is a 599-bed short-term, acute care, for profit hospital, located in Las Vegas, Nevada. According to CMS’s National Claims History (NCH) data, Medicare paid the Hospital approximately $245 million for 15,000 inpatient and 25,308 outpatient claims from January 1, 2017, through December 31, 2018 (audit period).Our audit covered about $41 million in Medicare payments to the Hospital for 2,117 claims that were potentially at risk for billing errors. We selected for review a stratified random sample of 100 claims (85 inpatient and 15 outpatient) with payments totaling $2.4 million. Medicare paid these 100 claims during our audit period.We focused our audit on the risk areas that we identified as a result of prior OIG audits at other hospitals. We evaluated compliance with selected billing requirements.

This audit report shows the FCC determined that the agencywide charge card program’s risk of illegal, improper, or erroneous use was low and did not plan to include an audit or inspection of the FCC's purchase card and travel card programs in the OIG’s fiscal year 2021 and 2022 work plan.

The VA Office of Inspector General (OIG) conducted a national review to evaluate colonoscopy care delivered in Veterans Health Administration (VHA) multispecialty community-based outpatient clinics (CBOC). This review focused on quality indicators for CBOC colonoscopy providers’ practice evaluations, the extent to which CBOC colonoscopy procedure quality assurance monitoring occurred, CBOC emergency care preparations, and facility and national quality assurance monitoring.The OIG determined that VHA’s required colonoscopy quality indicators were not monitored in a standardized way that allowed for verification of the quality of colonoscopies performed by CBOC providers.Further, the OIG determined that colonoscopy quality indicator data was not analyzed for CBOC providers in a way that facilitated comprehensive quality assurance. CBOC, facility, and VHA leaders could not consistently identify gaps in colonoscopy quality at the CBOCs due to lack of standardized monitoring processes.CBOC staff managed potential risks associated with colonoscopy procedures and complied with VHA requirements for monitoring patients during colonoscopies, having emergency medical equipment available, and having an after-hours medical emergency policy.VHA’s colorectal cancer screening directive lacked requirements for monitoring compliance with VHA’s colonoscopy quality indicators, and the OIG identified potential recurring gaps in colonoscopy quality monitoring.The OIG identified limitations in VHA’s National Gastroenterology Program Office’s ability to monitor colonoscopies for quality assurance because of variations in quality indicator data collection and lack of consistency in implementation of endoscopy software as a data collection tool.The OIG made three recommendations to the Under Secretary for Health related to requirements for colonoscopy quality indicators in professional practice evaluation, colonoscopy quality assurance monitoring, and evaluating and recommending endoscopy software for standardized implementation for quality assurance monitoring.

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