Federal Reports

Under the home health prospective payment system (PPS), the Centers for Medicare & Medicaid Services pays home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary receives. The PPS payment covers part-time or intermittent skilled nursing care and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who were not confined to the home (homebound) or were not in need of skilled services.Our objective was to determine whether Southeastern Home Health Services (Southeastern) complied with Medicare requirements for billing home health services on selected types of claims.

What We Looked AtIn the last 5 years, fatalities in crashes involving large trucks or buses increased by 10.6 percent. As part of its mission, the Federal Motor Carrier Safety Administration (FMCSA) oversees its medical certification program and promotes safety through regulations, policies, and monitoring of certified medical examiners and driver examinations. In May 2014, FMCSA initiated the National Registry of Certified Medical Examiners (National Registry) to assist in verifying that medical examiners can effectively determine if interstate commercial drivers meet FMCSA’s physical qualification standards. We initiated this audit given the significant safety risk posed by drivers who do not meet physical qualification requirements. Our audit objectives were to evaluate FMCSA’s procedures for overseeing its medical certificate program. Specifically, we analyzed FMCSA’s procedures for (1) validating and maintaining data quality in the National Registry and (2) monitoring medical examiner eligibility and performance and reviewing driver examinations.What We FoundFMCSA’s ability to oversee whether drivers meet physical qualification standards to safely operate a commercial vehicle is limited because of a lengthy outage of the National Registry and a resulting backlog of driver examination reports that were not entered into the Registry. In addition, weaknesses associated with the accuracy and completeness of data in the National Registry limit the effectiveness of FMCSA’s oversight. Furthermore, FMCSA has not fully implemented requirements for random periodic monitoring of medical examiners’ eligibility and performance. While FMCSA has conducted initial certification reviews of medical examiners’ eligibility qualifications, the Agency is not yet conducting annual eligibility audits after initial certification. Without these oversight reviews, FMCSA may be missing fraud indicators or other risks that may require mitigation and has less assurance that drivers are physically qualified to safely operate a commercial vehicle.Our RecommendationsWe conducted our audit of FMCSA’s medical certification program during a transition period while the Agency is working to design and deploy a new National Registry. FMCSA concurred with our four recommendations to improve FMCSA’s oversight of its medical certification program once the Agency deploys its new National Registry. 

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the VA Central Iowa Health Care System (facility) in Des Moines in response to an OIG Office of Investigations referral regarding a facility report that a urologist practiced, was privileged, and ordered controlled substances without a Drug Enforcement Administration (DEA) registration.The OIG confirmed the facility’s report regarding the urologist and assessed facility medical staff management processes. The OIG found that the urologist was able to practice and was privileged without DEA credentials because facility leaders did not timely implement a Veterans Health Administration (VHA) directive requiring providers who ordered controlled substances to possess an individual DEA registration. Upon recognizing that the urologist verbally ordered controlled substances in the operating room without a DEA registration, facility leaders took action by notifying the OIG Office of Investigations of the urologist’s unauthorized ordering, suspending the urologist’s privileges for one month, and implementing a process to ensure all controlled substance ordering providers, including the urologist, hold an active DEA registration. The failure of the urologist to timely obtain a DEA registration was not related to clinical competency.The OIG was concerned, however, that the facility’s operating room practice permitted surgeons to issue verbal orders for nonurgent medications without subsequently entering the medication orders in the computer. The practice bypassed quality controls and prevented pharmacists and controlled substance inspectors from reviewing medication orders. The OIG made five recommendations to the Facility Director related to monitoring compliance with VHA and facility policies to maintain DEA registrations and management of medications in the operating room.

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A Pennsylvania man pleaded guilty in U.S. District Court, Northern District of Illinois, to theft of government funds on January 12, 2021. Our investigation disclosed that Ryan Kane, a resident of Philadelphia, participated in a scheme to defraud Amtrak and others by using stolen credit card information from more than 10 credit cards to purchase Amtrak tickets online. Kane then cancelled the Amtrak tickets and received vouchers for the value of those tickets from Amtrak. Kane sold the Amtrak vouchers on eBay at a fraction of their face value. As a result, Kane fraudulently caused Amtrak to issue more than $35,000 in ticket vouchers.In addition, Kane conspired with Christian Newby by showing him how to execute the scheme. Newby, a resident of Milan, Michigan, defrauded Amtrak of more than $540,000 and was sentenced to 72 months in federal prison in September 2020.Kane will be sentenced at a future date.