Federal Reports

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.

ARC awarded the grant funds to support the renovation of the vacant Willis Building in downtown St. Paul

ARC awarded the grant funds to support the expansion of health care services for under-served populations in Cherokee County and surrounding areas by establishing free clinics and mobile medical services

The grant provided ARC funding to support a project entitled "Connecting People to the West Alabama Automotive Pipeline"

The grant provided ARC funding to support Bevill State Community College (BSCC) in operating the Alabama Appalachian Higher Education (AAHE) Center and implementing project to improve the post-secondary education levels in distressed areas of six Western Alabama counties.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Dayton VA Medical Center, Ohio (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health Care: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-Up; and High-Risk Processes: Central Line-Associated Bloodstream Infections. Three of four Facility leadership positions were filled by interim or acting staff, with long-term Facility leaders in two positions. Organizational leaders supported patient safety and quality care. The OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. The leadership team was knowledgeable about selected SAIL metrics but should continue to take actions to improve care and performance of selected Quality of Care and Efficiency metrics likely contributing to the current “4-Star” rating. The OIG noted findings in four of eight areas of clinical operations reviewed and issued 10 recommendations attributable to the Chief of Staff and Associate Director. The identified areas with deficiencies were: (1) Quality, Safety, and Value • Completion of inpatient admissions and continued stay reviews • Physician Utilization Management (UM) Advisors’ documentation of decisions • Interdisciplinary review of UM data (2) Credentialing and Privileging • Focused Professional Practice Evaluation processes (3) Environment of Care • Completion of Environment of Care (EOC) rounds • Facility cleanliness and maintenance • Medical equipment safety inspections (4) Long-term Care: Geriatric Evaluations • Program oversight and evaluation • Medical evaluation • Implementation of interdisciplinary plan of care

The VA Office of Inspector General (OIG) conducted a rapid response healthcare inspection after an OIG Comprehensive Healthcare Inspection Program review identified several significant environment of care (EOC) deficiencies at the McComb Community Based Outpatient Clinic (CBOC) on May 23, 2018. The purpose of the inspection was to assess EOC conditions at the remaining six contract CBOCs under the auspices of the G.V. (Sonny) Montgomery VA Medical Center (Facility) in Jackson, Mississippi. On May 30, three OIG teams conducted unannounced inspections at the Columbus, Greenville, Hattiesburg, Kosciusko, Meridian, and Natchez, Mississippi, CBOCs. OIG inspectors did not identify deficiencies related to general privacy requirements or the availability of medical equipment and supplies. The OIG inspectors found general safety, medication safety and security, infection prevention and environmental cleanliness, and information technology deficiencies. While OIG inspectors did not find that those conditions placed patients or staff at risk, corrective actions were needed to ensure a clean, healthy, and safe environment for patients and staff. The OIG team found inconsistencies between the requirements for Veterans Health Administration oversight as described in the respective CBOC contracts, the Contracting Officer’s Representative expectations, and Facility managers’ approach to CBOC site visits. In addition, when Facility managers conducted CBOC inspections, they did not consistently keep written records of what was reviewed, deficiencies found, or required dates for correction. The OIG team briefed Facility leaders on the results of the inspection findings on June 7, 2018. The OIG made two recommendations related to Facility comprehensive reviews of environment of care issues and consistent oversight of the CBOC operations.

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Ann Arbor Healthcare System (Facility). The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health Care: Post-Traumatic Stress Disorder Care; Long-Term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-Up; and High-Risk Processes: Central Line-Associated Bloodstream Infections. The OIG also provided crime awareness briefings to 124 employees. The Facility has a relatively new executive leadership team that appears stable and actively engaged with employees and patients. The executive leaders support efforts related to patient safety, quality care, and other positive outcomes (such as initiating processes and plans to maintain positive perceptions of the Facility through active stakeholder engagement). The OIG’s review of accreditation organization findings, sentinel events, disclosures, Patient Safety Indicator data, and Strategic Analytics for Improvement and Learning (SAIL) results did not identify any substantial organizational risk factors. Although the senior leadership team was knowledgeable about selected SAIL metrics, the leaders should continue to take actions to maintain care and performance of selected SAIL metrics likely contributing to the current “4-Star” rating. The OIG noted findings in three of the eight areas of clinical operations reviewed and issued three recommendations that are attributable to the Director, Chief of Staff, Associate Director, and Assistant Director. The identified areas with deficiencies are: (1) Credentialing and Privileging • Focused Professional Practice Evaluations (2) Environment of Care • Environment of care rounds attendance (3) Medication Management: Controlled Substances (CS) Inspection Program • Reconciliation of CS dispensing and return of stock