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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
Department of Health & Human Services
Hospitals Received Millions in Excessive Outlier Payments Because CMS Limits the Reconciliation Process
Outlier claim payments are based on hospital cost reports from the latest cost-reporting period for which the cost report is either settled as final or tentatively settled. The Centers for Medicare & Medicaid Services (CMS) requires its Medicare administrative contractors to reconcile outlier payments by using information from the updated current cost-reporting period, but only if the cost report meets the following criteria: the actual cost-to-charge ratio (CCR) is found to be plus or minus 10 percentage points from the CCR applied during the payment period (10-percentage-point threshold), and the outlier payments in that cost reporting period exceed $500,000.
The Tennessee Valley Authority Office of the Inspector General meets its legal requirement to report to Congress on its results twice a year through its Semiannual Report to Congress.
The overall assessment of the Commission's FY 2019 information security program was deemed not effective because the tested, calculated and assessed maturity levels across the functional and domain areas received an overall rating at Level 3 – Consistently Implemented. The findings from the evaluation demonstrate that improvements are needed with respect to continuous monitoring and information system and communication.
