Federal Reports

As a part of our oversight responsibilities for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) appropriations to the U.S. Department of the Interior (DOI), we have reviewed the Office of Insular Affairs’ (OIA’s) initial oversight steps for the CARES Act grant funds to the Insular Area governments.The CARES Act provided the DOI with $756 million to support the needs of its programs, bureaus, Indian Country, and the Insular Areas. The OIA was allocated $55 million, which it distributed to the seven Insular Area governments through its Technical Assistance Program (TAP) Office in April 2020, to help prepare for, prevent, and respond to the COVID-19 pandemic. The Republic of the Marshall Islands received $3.9 million of the CARES Act funds, to be expended by September 30, 2021. As part of the award, the Marshall Islands must meet the grant terms and conditions, which include a requirement to document how it used the funds to prevent and respond to the pandemic and how the funds supported its pandemic plan.We issued this management advisory to the Marshall Islands’ Office of the Auditor General to share some of the lessons we have learned from auditing grant awards during emergency situations. We attached two of our CARES Act flash reports, The Office of Insular Affairs Took Appropriate Action With CARES Act Funds and Lessons Learned for CARES Act Awards, for additional information. We also discussed challenges unique to the Marshall Islands.

The Office of Inspector General is required by statute to report annually the most serious management and performance challenges facing the Department of Commerce. Attached is our final report on the Department’s top management and performance challenges for fiscal year 2021.

Medicare paid hospitals $372 million for bariatric surgeries provided to Medicare beneficiaries in calendar years 2015 and 2016. Bariatric surgery helps those with morbid obesity to lose weight by making changes to their digestive system. Although OIG has not conducted an audit in this area, the Centers for Medicare & Medicaid Services’ (CMS’s) study of certain bariatric surgery procedure codes found that 98 percent of improper payments lacked sufficient documentation to support the procedures. After analyzing Medicare claim data for bariatric surgery claims with dates of service from January 2015 through December 2016 (audit period), we selected for audit Cedars-Sinai Medical Center (Cedars-Sinai), located in Los Angeles, California. Our objective was to determine whether Cedars-Sinai complied with Medicare requirements and the Medicare contractor’s local coverage determinations (LCDs) and local coverage article (LCA) when billing for bariatric surgeries.Our audit covered $1.3 million in Medicare payments to Cedars-Sinai for 62 bariatric surgery claims. We reviewed the beneficiaries’ medical records to determine whether the claims met Medicare requirements and the specifications in Noridian Healthcare Solutions, LLC’s (Noridian’s) LCDs and LCA for bariatric surgery. An independent medical review contractor reviewed the medical records for 23 claims.

An Amtrak coach cleaner in Chicago, Illinois, was terminated from employment on October 14, 2020, following her administrative hearing. The former employee participated in a medical fraud scheme in violation of company policies. Our investigation found that the former employee provided a chiropractor based in Dolton, Illinois, with her medical and personally identifiable information and that of her dependents in exchange for cash kickbacks. The chiropractor used the information to fraudulently bill Amtrak’s health insurance plan for services that were not provided.