Federal Reports

Under the Medicare 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 Gem City Home Care, LLC, (Gem City) complied with Medicare requirements for billing home health services on selected types of claims.Our audit covered $35,689,451 in Medicare payments to Gem City for 10,417 claims. These claims were for home health services provided in fiscal years 2016 and 2017. We selected a stratified random sample of 100 claims with payments totaling $385,724 for review. We evaluated compliance with selected billing requirements and submitted these claims to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

Summary of the top management and performance challenges facing ARC.

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. American Samoa received $4.08 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, American Samoa must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory American Samoa’s Office of the Territorial Audit Office to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards, for additional information.

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. The Commonwealth of the Northern Mariana Islands (CNMI) received $4.04 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, the CNMI must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory to the CNMI’s Office of the Public Auditor to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards , for additional information. We also discussed challenges unique to the CNMI.

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. The Federated States of Micronesia (FSM) received $7.74 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, the FSM must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory the FSM’s Office of the National Public Auditor to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards, for additional information. We also discussed challenges unique to the FSM.

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. Guam received $12.04 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, Guam must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory to Guam’s Office of Public Accountability to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards, for additional information. We also discussed challenges unique to Guam.

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. The Republic of Palau received $1.59 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, Palau must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory to Palau’s Office of the Public Auditor to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards, for additional information. We also discussed challenges unique to Palau.