Federal Reports

OIG PEER REVIEW

Medicare payments may not be made for items or services that “are not reasonable andnecessary for the diagnosis or treatment of illness or injury or to improve the functioning of amalformed body member” (Social Security Act (the Act) § 1862(a)(1)(A)). In addition, the Actprecludes payment to any provider of services or other person without information necessaryto determine the amount due the provider (§ 1815(a)).Federal regulations state that the provider must furnish to the Medicare contractor sufficientinformation to determine whether payment is due and the amount of the payment (42 CFR§ 424.5(a)(6)).Claims must be filed on forms prescribed by CMS in accordance with CMS instructions (42 CFR§ 424.32(a)(1)). The Medicare Claims Processing Manual (the Manual) requires providers tocomplete claims accurately so that Medicare contractors may process them correctly andpromptly (Pub. No. 100-04, chapter 1, § 80.3.2.2). The Manual states that providers must useHCPCS codes for most outpatient services (chapter 23, § 20.3).3The Office of Inspector General (OIG) believes that this audit report constitutes credibleinformation of potential overpayments. Upon receiving credible information of potentialoverpayments, providers must exercise reasonable diligence to identify overpayments (i.e.,determine receipt of and quantify any overpayments) during a 6-year lookback period.Providers must report and return any identified overpayments by the later of (1) 60 days afteridentifying those overpayments or (2) the date that any corresponding cost report is due (ifapplicable). This is known as the 60-day rule.4The 6-year lookback period is not limited by OIG’s audit period or restrictions on theGovernment’s ability to reopen claims or cost reports. To report and return overpaymentsunder the 60-day rule, providers can request the reopening of initial claims determinations,submit amended cost reports, or use any other appropriate reporting process.

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 complied with Federal and State requirements when claiming Federal Medicaid reimbursement for Medicaid services provided to beneficiar

At the request of the Tennessee Valley Authority's (TVA) Supply Chain, we examined a cost proposal for engineering, design, and construction support services. Our examination objective was to determine if the cost proposal was fairly stated for a planned 5-year, $300 million contract.In our opinion, the cost proposal was overstated. Specifically, we found the proposed labor markup rates, for recovery of indirect costs, were overstated compared to recent actual costs. We estimated TVA could save about $4 million over the planned $300 million contract spend by negotiating reduced labor markup rates to more accurately reflect recent actual costs.(Summary Only)

The objectives were to determine whether USPTO (1) achieved its small business utilization goals, (2) contracting officials provided small businesses with adequate contract award opportunities, and (3) took appropriate actions to ensure contracting officials met small business contracting goals. We contracted with Booth Management Consulting, LLC (BMC)—an independent firm—to perform this audit of USPTO. Our office oversaw the progress of this audit to ensure that BMC performed the audit in accordance with generally accepted government auditing standards and contract terms. However, BMC is solely responsible for the attached report and conclusions expressed in it. As discussed in the attached report, BMC concluded that USPTO did not (1) meet its small business utilization goals, (2) provide small businesses with adequate contract award opportunities, and (3) take appropriate actions to meet small business contracting goals. BMC recommended in the report that the Under Secretary of Commerce for Intellectual Property and Director of the U.S. Patent and Trademark Office direct the Director of the Office of Procurement to ensure that the following occur: (1) Contract specialists verify small business eligibility prior to awarding small business contracts. (2) Contract specialists perform and appropriately document small business set-aside reviews. (3) Historically Underutilized Business Zones small business consideration is included in its annual acquisition forecasting activities and marketing efforts to maximize contracting opportunities. (4) The Office of Procurement uses the Forecasting and Advanced Acquisition Planning System and establishes clear lines of communication between the Office of Procurement, small business specialists, and contracting specialists for all procurement requests.

During our unannounced inspections of five U.S. Customs and Border Protection (CBP) facilities in the Laredo and San Antonio areas of Texas in February 2020, three Border Patrol stations and two Office of Field Operation ports of entry we visited appeared to be operating in compliance with the Transport, Escort, Detention, and Search (TEDS) standards we evaluated. We verified accessibility to water, food, toilets, sinks, basic hygiene supplies, and bedding. We observed clean facilities and verified that temperatures and ventilation in holding rooms were appropriate. Of the five facilities we visited, only one could provide on-site showers to detainees, but during our visits, no detainees were approaching the detention time threshold where a shower would be required. Because Border Patrol leadership directed all Border Patrol stations to implement Phase 2 of the enhanced medical screening ahead of the prescribed schedule outlined in CBP Directive 2100-004, the Border Patrol stations we visited were conducting alien intake health assessments using CBP Form 2500. These Ports of Entry had implemented Phase 1, but were not yet required to conduct Phase 2 assessments at the time of our inspection. We did not make any recommendations in this report.

We are issuing this management alert to advise the Department of Homeland Security and CBP of the urgency and short timeframe to award a new medical services contract. During two ongoing projects, we learned that CBP’s current contract for medical services will expire on September 29, 2020. As of September 3, 2020, CBP had not issued a solicitation for a new contract, leaving fewer than 30 days for necessary funding, reviews, and approvals before CBP can award the contract. A lapse in this contract could jeopardize the health and safety of migrants in CBP custody, as well as that of U.S. Border Patrol agents, CBP officers, and staff, during the current pandemic. We recommended that CBP dedicate all available resources necessary to its planning and communication to ensure continuity of CBP’s onsite medical services and that CBP conduct future contract planning and communication in a timely manner. CBP concurred with this recommendation.