Federal Reports

Our objective was to determine whether the Social Security Administration (SSA) appropriately assigned Social Security numbers (SSN) to noncitizens with a valid nonwork reason.

From July 1, 2016, through December 31, 2018 (audit period), Medicare paid approximately $4 billion for 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 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 claim data, we selected for audit Desoto Home Health Care, Inc. (Desoto), an orthotic braces supplier in Wauchula, Florida.

Effective in 2018, the Medicare program changed the way it sets payment rates for clinical diagnostic laboratory tests (lab tests). CMS replaced the previous payment rates with new rates based on private payer data collected from labs. This is the first reform in 3 decades to Medicare's payment system for lab tests. As part of the same legislation reforming Medicare's payment system, Congress mandated that OIG monitor Medicare payments for lab tests and the implementation and effect of the new payment system for those tests.

The VA Office of Inspector General (OIG) reviewed VA facilities and community providers for usage of health information exchanges (HIEs) in their respective communities and to identify any barriers that may impede the use of HIEs. HIEs share patient health record information electronically and coordinate care for enrolled veterans. The VA MISSION Act of 2018 included language to improve information sharing between the Veterans Health Administration (VHA) and the community. The Veterans Health Information Exchange program office has two methods to share information with the community, via internet exchange (VA Exchange) and email exchange (VA Direct). Exchanging health information electronically provides a secure method for healthcare providers to share veteran health information. The OIG conducted a survey and interviewed the 48 lower complexity level 2 and 3 VHA facilities because of the higher expected use of community providers. Additionally, the OIG interviewed staff from the offices of Veterans Health Information Exchange (VHIE), Information Technology, Community Care, and Rural Health; two state health information exchanges; and Cerner Corporation. VA has two contracts establishing community coordination for VHIE. The performance work statements for the contracts require coordinators to provide training, policy, and process assistance to VHA directors and staff. The OIG reviewed the performance work statements for these contracts. During facility interviews, the staff cited the most challenges in training, the need for more community partners, use of contract community coordinators, and technology. Those using either VA Exchange or VA Direct cited successes and felt with more community participation the goals of the program were achievable. The OIG made four recommendations to the Under Secretary for Health related to the need for increased utilization of VA Direct, education for staff and veterans on VA Exchange and VA Direct, expansion of community partnerships, and use of contract VHIE community coordinators.

This audit is a follow-up to our 2014 white paper on reform of the Federal Employees’ Compensation Act. Our objective was to determine the current status of Postal Service cost-containment activities related to workers’ compensation costs and liabilities.