Federal Reports

We selected Gracie Station based on our analysis of stop-the-clock (STC) scan data from the Product Tracking and Reporting (PTR) system. Specifically, we used geolocation data to identify packages with STC scans with a scan event of “Delivered” that occurred at the delivery unit property instead of the intended delivery address. The unit had 10,421 scans of “Delivered” at the delivery unit in fiscal year (FY) 2019, Quarter (Q) 3. Our objective was to evaluate the package delivery scanning process on select routes at Gracie Station

We issued this to (1) determine whether the Social Security Administration (SSA) made payments to beneficiaries and representative payees who were deceased according to New Mexico Department of Health vital records and (2) identify non-beneficiaries who were deceased according to the State file but whose death information did not appear in the Agency’s records.

Three Amtrak employees in Los Angeles, California, were terminated from employment on May 15, 2019, June 19, 2019, and September 5, 2019, following administrative hearings for violating company policies. Our investigation found that these employees changed their employment codes in the company’s electronic time keeping system resulting in an unauthorized increase in pay. One employee received an overpayment of over $35,000.00, another received an overpayment of over $23,000.00 and the final employee received an overpayment of over $21,000.00.

CMS could use Comprehensive Error Rate Testing (CERT) data to identify high-risk home health agencies (HHAs) as a part of a multifaceted approach that includes targeted probe-and-educate reviews as well as aspects of its Fraud Prevention System to further reduce improper payments and the error rate for claims paid to HHAs. Using nationally reported CERT program data for fiscal years (FYs) 2014 through 2017, we identified 87 high-risk HHAs, which in the CERT sample had an improper payment rate of about 78 percent and approximately $1 million in actual improper payments. Using Medicare program data during this same period, we determined that Medicare paid these 87 HHAs more than $4 billion for services.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review the utilization of hospice and palliative care (HPC) services at the Veterans Health Administration (VHA). The OIG reviewed relevant directives, policies, handbooks and conducted interviews with VHA and non-VHA HPC subject matter experts. After reviewing relevant documentation and conducting interviews, the OIG examined the electronic health records of patients who were newly diagnosed with a malignant cancer in fiscal year 2017 to determine how many patients received a formal HPC consult or had an informal HPC-related discussion with a provider. The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code. In addition, the OIG chose to examine a different aspect of HPC to determine whether completed HPC consults were linked to required stop codes used to measure HPC workload. The OIG found that 78.5 percent were appropriately linked to an HPC stop code and 21.5 percent were not. The OIG found that the administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicates that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect allocation of resources and planning. In summary, this review identified areas where VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services. The OIG made one recommendation to the Under Secretary for Health to ensure the development and implementation of a consistent and standardized approach for hospice and palliative care documentation, consult management, and coding.

Spinal conditions account for two of VA’s top 10 service-connected disabilities, totaling some 1.5 million cases as of September 30, 2018. The VA Office of Inspector General (OIG) conducted this review after determining disability claims related to conditions of the spine have a higher risk of processing errors, which can result in veterans not receiving the proper benefits. The OIG estimated the Veterans Benefits Administration (VBA) incorrectly processed more than half of the 62,500 claims decided in the first six months of 2018, accounting for at least $5.9 million in either over- or underpayments. Processing errors included improper evaluations, missed secondary conditions, and evaluations based on inadequate exams. The OIG found these incorrectly decided claims resulted from VBA’s inadequate process for ensuring accurate and complete evaluation. VBA’s primary means of evaluating disability contains minimal guidance and a procedure manual is too subjective in key areas, which can lead to an inconsistent evaluation for related conditions stemming from the primary disability. During the review, VBA acknowledged issues the OIG identified were problematic and that it has taken steps to update some of its tools and guidance. VBA has also initiated mandatory training to help employees who approve and review claims better understand medical opinions. The OIG recommended the under secretary for benefits instruct VBA to update its disability rating process to establish objective criteria for spine-related conditions and improve VBA’s internal controls to help ensure the accuracy and consistency of claims decisions for conditions of the spine.