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 intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

The DHS Chief Information Officer (CIO) and most component CIOs had conducted strategic planning efforts to help prioritize legacy Information Technology (IT) systems and infrastructure to better accomplish mission goals. However, due to a lack of standard guidance and funding, not all components have complied with or fully embraced Department-wide IT modernization initiatives to adopt cloud-based computing, and to consolidate data centers. Meanwhile, DHS continues to rely on deficient and outdated IT systems to perform mission-critical operations. Additionally, DHS has not yet leveraged the Modernizing Government Technology Act mandate to accelerate ongoing IT modernization efforts, as DHS and its components questioned whether the benefits of the Act outweighed the additional effort needed to use the resources provided under the Act. Until DHS addresses these issues, it will continue to face significant challenges to accomplish mission operations efficiently and effectively. We made three recommendations for the DHS OCIO to develop guidance for implementing cloud technology and migrating legacy IT systems to the cloud, coordinate with components to develop and finalize a data center migration approach, and establish a process to assign risk ratings for major legacy IT investments. The Department concurred with all three recommendations.

On August 10, 2020, OIG sent letters to the leadership of state and territorial public utility commissions seeking to strengthen its ongoing relationships with these important partners. Frequently the first to receive complaints and concerns regarding the Lifeline program (and other FCC-administered programs) from beneficiaries and the public, OIG encourages public utility commissions to continue sharing information critical to fulfilling our mandate to detect and combat fraud, waste and abuse in FCC programs.

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 intermittent skilled nursing and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies.

From January 1, 2016, through May 31, 2018 (audit period), Medicare paid $1.5 billion for knee, back, and ankle-foot braces (selected orthotic braces) provided to Medicare beneficiaries. Prior OIG audits and evaluations found that some suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) billed for orthotic braces that did not comply with Medicare billing requirements. During our audit period, the Centers for Medicare & Medicaid Services found that orthotic braces were among the top 20 DMEPOS items with the highest improper payment rates. After analyzing Medicare claims data, we selected for audit Visionquest Industries, Inc. (Visionquest), an orthotic braces supplier in Irvine, California.