Federal Reports

What We Looked AtWe reviewed the North Coast Railroad Authority's single audit report for the fiscal year ending June 30, 2017, in order to identify findings that affect directly awarded Department of Transportation programs. An independent auditor prepared the single audit report, dated March 27, 2018.What We FoundWe found that the report contained a reporting requirements finding that needs prompt action from the Office of the Secretary's (OST) management.RecommendationsWe recommend that OST ensures that the North Coast Railroad Authority complies with the reporting requirements.

What We Looked AtWe reviewed the San Francisco Municipal Transportation Agency's single audit report for the fiscal year ending June 30, 2017, in order to identify findings that affect directly awarded Department of Transportation programs. An independent auditor prepared the single audit report, dated March 29, 2018.What We FoundWe found that the report contained a procurement, suspension, and debarment finding that needs prompt action from the Federal Transit Administration's (FTA) management.RecommendationsWe recommend that FTA ensures that the Agency complies with the procurement, suspension, and debarment requirements. We also recommend that FTA recovers $214,494 from the Agency, if applicable.

What We Looked AtWe reviewed the State of North Carolina's single audit report for the fiscal year ending June 30, 2017, in order to identify findings that affect directly awarded Department of Transportation programs. An independent auditor prepared the single audit report, dated March 19, 2018.What We FoundWe found that the report contained a special tests and provisions finding that needs prompt action from the Federal Highway Administration's (FHWA) management.RecommendationsWe recommend that FHWA ensures that the State complies with the special tests and provisions requirements.

What We Looked AtWe reviewed the Puerto Rico Highways and Transportation Authority's single audit report for the fiscal year ending June 30, 2016, in order to identify findings that affect directly awarded Department of Transportation programs. An independent auditor prepared the single audit report, dated April 6, 2018.What We FoundWe found that the report contained subrecipient monitoring requirements, special tests and provisions requirements, and matching requirements findings that need prompt action from the Federal Highway Administration's (FHWA) management and the Federal Transit Administration's (FTA) management.RecommendationsWe recommend that FTA ensures that the Authority complies with the subrecipient monitoring requirements. We recommend that FHWA ensures that the Authority complies with the special tests and provisions requirements and the matching requirements.

Medicare payments to providers for emergency ambulance transports did not comply or potentially did not comply with Federal requirements. Specifically, Medicare made improper and potentially improper payments totaling $1.9 million: (1) improper payments of $975,154 for transports to destinations that were not covered by Medicare for either emergency or nonemergency ambulance transports, including the identified ground mileage associated with the transports, and (2) potentially improper payments of $928,092 for transports that may not have met Medicare coverage requirements or might have been paid by Medicare as nonemergency ambulance transports. During our audit period (calendar years 2014 through 2016), the Centers for Medicare & Medicaid Services (CMS) did not require the Medicare contractors to implement nation-wide prepayment edits that would either deny payments or mandate prepayment review for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities.

Payments for outpatient intensity-modulated radiation therapy (IMRT) planning services did not comply with Medicare billing requirements. Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning. The overpayments primarily occurred because the hospitals appeared to be unfamiliar with or misinterpreted the Centers for Medicare & Medicaid Services (CMS) guidance. In addition, the claim processing edits did not prevent the overpayments because the edits applied only to services billed on the same date of service as the billing of the procedure code for the bundled payment, and the services in our sample were billed on a different date of service. (Medicare makes a bundled payment to hospitals to cover a range of IMRT planning services that may be performed to develop an IMRT treatment plan.) On the basis of our sample results, we estimated that Medicare overpaid hospitals nation-wide as much as $21.5 million for complex simulations billed during our audit period (for calendar years (CYs) 2013 through 2015). In addition, we identified $4.2 million in potential overpayments for other IMRT planning services that were not included in our sample. In total, Medicare overpaid hospitals as much as $25.8 million during our audit period.