Federal Reports

Previous OIG work found that Medicaid may have paid for drugs in 2008 that were not approved by the Food and Drug Administration (FDA) as safe and effective. To qualify for Federal payments under Medicaid, drugs must be FDA-approved unless they meet the criteria for an exception-for example, prescription prenatal vitamins or drugs that are prescribed during times of drug shortages.

On January 31, 2018, the VA Office of Inspector General (OIG) received allegations that a psychologist at the Temple campus of the Central Texas Veterans Health Care System double-coded group therapy sessions and received improper overtime pay. Double coding refers to inappropriately entering duplicate codes to a patient encounter when only a single code would be appropriate. This audit substantiated that the psychologist improperly coded mental health services for about 66 percent of patient encounters for a 20-week period. The psychologist double-coded services, used codes not supported by the medical documentation, and entered codes not permitted for psychologists’ use. Also, the psychologist received about $7,700 in salary for clinic time not spent providing direct patient care and more than 243 hours in unnecessary overtime pay. During the review, the team developed concerns that other psychologists were also coding patient encounters improperly. The OIG found similar errors, except for double coding. The team estimated that other psychologists entered improper codes for about 29 percent of the encounters completed during the same period. The coding errors occurred because the chief of psychology failed to make sure that staff attended training or otherwise received proper instruction. The chief also failed to provide oversight by not reviewing the health care providers’ coding for accuracy. Furthermore, the chief of Health Information Management failed to perform mandatory annual coding reviews for each provider. The OIG recommended stronger oversight and that the director of the Central Texas Veterans Health Care System ensure all psychologists receive medical coding training. The OIG also recommended improving the review of overtime hours, ensuring facility hours are used to provide direct patient care, and confirming psychologists follow VHA’s scheduling policies and use approved systems.

DOL-OIG bi-monthly Investigations Newsletter Volume XXI, for the period of February 1 - March 31, 2019.

Amtrak (the company) contracted with the independent certified public accounting firm of Ernst & Young LLP to audit its consolidated financial statements as of September 30, 2018, and for the year then ended, and to provide a report on internal control over financial reporting and on compliance and other matters. Because the company receives federal assistance, it must obtain an audit performed in accordance with generally accepted government auditing standards.As required by the Inspector General Act of 1978, we monitored the audit activities of Ernst & Young to help ensure audit quality and compliance with auditing standards. Our monitoring focused on two Ernst & Young reports and disclosed no instances in which Ernst & Young did not comply, in all material respects, with generally accepted government auditing standards.