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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Environmental Protection Agency
EPA May Have Overpaid for Its $13 Million Time and Attendance System by Not Following Information Technology Investment Requirements
An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare's Medical Necessity or Documentation Requirements
Under the inpatient psychiatric facility (IPF) prospective payment system (PPS), Medicare pays IPFs a standard per diem rate for inpatient services, modified for patient- and facility-level characteristics and length of stay. In addition, the IPF PPS includes an outlier payment policy that makes an additional payment in cases with unusually high costs to limit financial losses to IPFs.
Under the 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.
Williams-Adley determined that the Federal Emergency Management Agency (FEMA) did not ensure the Puerto Rico Central Office of Recovery, Reconstruction, and Resiliency (COR3) and the Puerto Rico Aqueduct and Sewer Authority (PRASA) establish and implement policies, procedures, and practices to account for and expend Public Assistance (PA) grant funds according to Federal regulations and FEMA guidance. Specifically, PRASA did not follow established policies and procedures for: (1) recording the capacity size and rate of its force account equipment; and (2) ensuring each vendor had a certificate of eligibility before receiving a contract award. We made two recommendations to improve PRASA’s management of FEMA PA funds, ensuring they are expended according to Federal regulations and FEMA guidance.
