Federal Reports

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), audited the Nampa Housing Authority’s public housing program in response to a local OIG, Office of Investigation, referral. Our objective was to determine whether the Authority followed U.S. Department of Housing and Urban Development (HUD) public housing requirements pertaining to (1) calculating contract rents, (2) maintaining its waiting lists, (3) providing its staff the credentials needed to access HUD systems, and (4) storing and securing tenant files.We found that the Nampa Housing Authority charged 11 tenants the incorrect rent for at least 1 month, improperly maintained its waiting lists by housing tenants out of order, could not show that all HUD system users had proper credentials and that only employees with credentials accessed the system, and generally stored and secured tenant files properly.We recommend that the director of the Seattle Office of Public and Indian Housing require the Nampa Housing Authority to (1) reimburse the six tenants who overpaid rent totaling $1,550 using non-Federal funds, (2) develop and implement internal control procedures that support its policy and ensure a proper tenant selection process when selecting tenants for housing, and (3) ensure that the Authority follows all applicable HUD requirements related to accessing, use, and safeguarding credentials of HUD systems.

While conducting a site visit for the Employee Safety – Postal Service COVID-19 Response audit, we identified building maintenance and safety issues at Philadelphia’s Spring Garden Station that were not directly related to the scope of the audit. Specifically, we identified 30 deficiencies ranging from minor to more serious violations. We believe these issues warrant management’s immediate attention and corrective action.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

The objective for this report was to assess the extent to which the company has taken steps to determine employees’ current perspectives on safety. We issued this report to provide our findings on a potential issue the company could address in the near term.We found that the company has not established a baseline measure of its own safety culture which is necessary to track its progress in improving its safety culture as a result of its investment in the SMS. According to a joint U.S. Department of Transportation (DOT) and Federal Railroad Administration study, as well as industry research, a primary method of establishing such a baseline is surveying employees’ values, attitudes, and perceptions about safety and the organization’s actions to improve it. We recommended the company develop and deploy an employee survey based on the DOT’s ten elements of a strong safety culture. The survey should be conducted in conjunction with planned training, or as soon as practical without delaying training. We also recommended the company use the survey’s results to measure its progress in improving safety culture over time and take action to address additional issues the survey identifies.

In 2010, Congress passed the Patient Protection and Affordable Care Act (ACA). The ACA established enhanced Federal reimbursement rates for services provided to nondisabled, low-income adults without dependent children (new adult group). The enhanced reimbursement rates established under the ACA have raised concerns about the possibility that States could improperly enroll individuals for Medicaid coverage in the new adult group and, as a consequence, the potential for improper payments.Our objective was to determine whether Colorado properly claimed reimbursement for Medicaid services provided from January 1, 2014, through September 30, 2015, to beneficiaries who were enrolled in the new adult group but who later became ineligible for Medicaid coverage.

BACKGROUNDThe Medicare ProgramTitle XVIII of the Social Security Act (the Act) established the Medicare program, which provideshealth insurance coverage to people aged 65 and over, people with disabilities, and people withend-stage renal disease. The Centers for Medicare & Medicaid Services (CMS) administers theMedicare program. Medicare Part B provides supplementary medical insurance for medicaland other health services, including critical care services performed by physicians. CMScontracts with Medicare administrative contractors (MACs) to process and pay Part B claims.Medicare Coverage of Critical Care ServicesCritical care is defined as medical care delivered directly by a physician or a qualified nonphysicianpractitioner for a critically ill or critically injured patient. A critical illness or injury isone that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. Critical care involves highcomplexity decision making to assess, manipulate, and support vital system functions to treatsingle or multiple vital organ system failure and prevent further life-threatening deteriorationof the patient's condition (HCPCS [Healthcare Common Procedure Coding System] and CPTCodebook 2016–2018, and CMS, Medicare Claims Processing Manual, Pub. No. 100-04,Chapter 12, § 30.6.12.A (the Manual)).The time that can be reported as critical care is the physician time spent engaged in workingdirectly related to the individual patient's care. That time must be spent either at the patient’simmediate bedside or elsewhere on the floor or unit as long as the physician is immediatelyavailable to the patient. When the physician is providing critical care services, he or she mustdevote his or her full attention to the patient and cannot provide services to any other patientduring the same period (HCPCS and CPT Codebook 2016–2018, and the Manual, Chapter 12,§ 30.6.12.C).Critical care is a time-based service. CPT code 99291 is used to bill for the first 30 to 74 minutesof critical care on a given date of service by a physician or physician group of the samespecialty. CPT code 99292 is used to bill for additional blocks of time of up to 30 minutes eachbeyond the first 74 minutes of critical care occurring on the same date. Critical care that is lessthan 30 minutes in total duration on a given date should be reported using another appropriateevaluation and management (E&M) code (HCPCS and CPT Codebook 2016–2018, and theManual, Chapter 12, § 30.6.12.F). See the Figure on the following page for an explanation ofhow to code critical care services according to the amount of time spent providing critical care.Medicare Requirements for Identifying and Returning OverpaymentsClinical Practices of the University of PennsylvaniaClinical Practices is the faculty practice group for the University of Pennsylvania PerelmanSchool of Medicine’s clinical departments. Clinical Practices has locations throughout thePhiladelphia, Pennsylvania, metropolitan area and includes physicians in 59 different medicalspecialties and sub-specialties. Clinical Practices operates as a University of Pennsylvaniadivision and is responsible for operating the Perelman School of Medicine faculty’s clinicalpractices, as well as other University of Pennsylvania Health System clinical practices. Duringour audit period, Novitas Solutions was the MAC that processed and paid Clinical Practices’claims.

On October 5, 2018, the President signed into law the GDA as part of the FAA Reauthorization Act of 2018 (P.L. No. 115-254, Subtitle F). The purpose of the GDA is to foster efficient administration of geospatial data, technologies, and infrastructure by improving the coordination and partnerships between the producers and consumers of geospatial information in Federal, State, Tribal, and local governments, the private sector, and academia. Additionally, the GDA is intended to reduce duplicative efforts to procure geospatial data, services, expertise, and technology within the Federal Government. To facilitate efficient geospatial activities in the Federal Government, the GDA formalizes geospatial-related committees and governance processes. Additionally, the GDA codifies portions of OMB Circular No. A-16, Coordination of Geographic Information, and Related Spatial Data Activities, and the tools used to develop, drive, and manage the National Spatial Data Infrastructure (NSDI).