Federal Reports

GHI, a subsidiary of EmblemHealth Services Company, LLC, administered Medicare operations under a Coordination of Benefits contract with CMS. During our audit period, GHI also performed Medicare work on the Medicare Secondary Payer Recovery and Benefit Coordination and Recovery contracts. GHI also performed work as a subcontractor on the Retiree Drug Subsidy contract. During our audit period, GHI had two defined-benefit pension plans: the GHI Local 153Pension Plan and the EHS Retirement Plan. This report addresses the Medicare segment pension assets for the EHS Retirement Plan for the period of January 1, 2015, through December 31, 2015. We are addressing the Medicare segment pension assets for the GHI Local 153 Pension Plan in a separate audit. Upon the curtailment of its pension plan, GHI identified Medicare’s share of the EHS Retirement Plan Medicare segment excess pension liabilities to be $778,811 as of December 31, 2015. We performed a prior pension segmentation audit of GHI (A-07-19-00561, July 25, 2019), which brought the EHS Retirement Plan Medicare segment pension assets to January 1, 2015. We recommended that GHI recognize $5,633,345 as the EHS Retirement Plan Medicare segment pension assets as of January 1, 2015.

GHI, a subsidiary of EmblemHealth Services Company, LLC, administered Medicare operations under a Coordination of Benefits contract with CMS. During our audit period, GHI also performed Medicare work on the Medicare Secondary Payer Recovery and Benefit Coordination and Recovery contracts. GHI also performed work as a subcontractor on the Retiree Drug Subsidy contract. During our audit period, GHI had two defined benefit pension plans: the Local 153 Plan and the EmblemHealth Services Company, LLC, Employees’ Retirement Plan. This report addresses the Medicare segment pension assets for the Local 153 Plan for the period of January 1, 2015, through August 31, 2016. We are addressing the Medicare segment pension assets for the EmblemHealth Services Company, LLC, Employees’ Retirement Plan in a separate audit. Upon the curtailment of its pension plan, GHI identified Medicare’s share of the Local 153 Plan Medicare segment excess pension liabilities to be $6,131,699 as of August 31, 2016. We performed a prior pension segmentation audit of GHI (A-07-19-00562, July 25, 2019), which brought the Local 153 Plan Medicare segment pension assets to January 1, 2015. We recommended that GHI recognize $31,821,914 as the Local 153 Plan Medicare segment pension assets as of January 1, 2015.

Medicare Parts A and B cover eligible home health services under a prospective payment system (PPS). The PPS 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. Under the home health PPS, CMS pays HHAs for each 60-day episode of care that a beneficiary receives.In prior years, our audits at other HHAs identified findings in the following areas:• beneficiaries did not always meet the definition of “confined to the home,”• beneficiaries were not always in need of skilled services,• HHAs did not always submit OASIS data in a timely fashion, and• services were not always adequately documented.For the purposes of this report, we refer to these areas of incorrect billing as “risk areas.”Our objective was to determine whether Mercy complied with Medicare requirements for billing home health services on selected types of claims.

The objective of our audit was to determine whether the University of North Georgia (North Georgia) had controls to ensure that it reported complete and accurate campus crime statistics under the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act). North Georgia did not have effective controls to ensure that it reported complete and accurate Clery Act crime statistics. North Georgia had processes for activities related to crime reporting under the Clery Act, including identifying its Clery Act geography, requesting crime statistics from local law enforcement agencies, identifying campus security authorities (CSAs) and collecting crime reports from CSAs, processing and compiling the crime information, and reporting the annual Clery Act crime statistics by the reporting deadline. However, these processes did not provide reasonable assurance that the reported crime statistics would be complete and accurate. Additionally, NorthGeorgia did not follow all applicable Clery Act requirements and guidance, which, if followed, would help support the completeness and accuracy of the reported crime statistics. For example, North Georgia did not properly identify its CSAs or follow all applicable requirements for identifying its Clery Act geography3 and requesting crime. statistics from local law enforcement.

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The Veterans Benefits Administration (VBA) manages VA’s disability compensation program, which pays benefits based on a veteran's degree of disability, ranging from 0 to 100 percent. When veterans are found 100 percent disabled or unemployable due to service-connected disabilities, VBA must also consider whether veterans qualify for permanent and total (P&T) disability status. The VA Office of Inspector General (OIG) examined whether VBA staff cited adequate medical evidence demonstrating that veterans met statutory requirements for P&T status. The review team found that 61 percent of the decisions sampled did not cite adequate medical evidence, and about 15,100 veterans received P&T status without this evidence. As a result, VA may have improperly paid an estimated $38 million in additional benefits for P&T veterans for dental care, as well as education benefits and healthcare coverage for dependents between October 1, 2017, and December 31, 2019. The OIG further estimated that VA may improperly pay more than $84 million over the next five years for these benefits. The review team determined that VA’s adjudication procedures manual is inconsistent with the statute on P&T status. The statute requires decision makers to be “reasonably certain” that a total disability is likely to continue throughout a veteran’s lifetime, while the manual allows them to establish P&T status without using this standard. In addition, decision makers did not always explain the reasons why they established P&T status in the rating decisions as required. The OIG recommended that VBA ensure the adjudication procedures manual is reviewed and updated for consistency with statute; revise procedures to ensure staff support P&T status decisions by citing evidence; and revise the title and language used in the decisions to more clearly explain the establishment of P&T status. The OIG also recommended VBA provide staff with appropriate training on the updated procedures.

The U.S. Postal Service has a formal role in the federal National Response Framework, which guides the country’s response to disasters and emergencies like hurricanes, bioterrorism, pandemics and other incidents. The OIG examined how the Postal Service continues to support the American public during the ongoing COVID-19 pandemic, even as the outbreak affects postal operations. The Postal Service has delivered essential items like prescriptions, unemployment benefit and stimulus payments, personal protective equipment, and coronavirus test kits. The Postal Service also has provided a backbone for the surge in ecommerce as more consumers buy household goods online. Ensuring the continuation of mail service during this challenging time is helping to keep the American public stay safe, secure, and connected.