Federal Reports

Hyperbaric oxygen therapy (HBO therapy) involves giving a patient high concentrations of oxygen within a pressurized chamber in which the patient intermittently breathes in 100-percent oxygen. A prior Office of Inspector General review identified issues with Medicare payments for HBO therapy. More recently, a review by a Centers for Medicare & Medicaid Services (CMS) contractor found that claims for HBO therapy services were denied because of a lack of medical documentation. In 2015, CMS began a prior authorization demonstration program for non-emergent HBO therapy to test its effectiveness.

Payments made to providers for specimen validity tests did not comply with Medicare billing requirements. Specifically, Medicare improperly paid 4,480 clinical laboratories and physician offices a total of $66.3 million for specimen validity tests billed in combination with urine drug tests. Centers for Medicare & Medicaid Services (CMS) officials explained that medically necessary tests used to diagnose certain conditions (which include the same tests that can be used to validate urine specimens) that are performed on the same day as a urine drug test for a single beneficiary should be a rare occurrence.

We initiated an investigation after receiving an allegation that employees at Chicago Union Station wrongfully kept approximately $1,700 in cash that was turned in to the ticket counter to be processed as “lost and found.”

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The OIG conducted a healthcare inspection to assess concerns about possible abuse, neglect, or financial exploitation of veterans residing in medical foster homes (MFH) operated by Mr. and Mrs. X under the purview of the Chalmers P. Wylie VA Ambulatory Care Center (facility), Columbus, Ohio. The OIG did not substantiate veterans residing in MFH-1 were at imminent risk for abuse or neglect. The OIG could not substantiate that the two veterans who designated Mr. X as financial power of attorney (POA) were at imminent risk for financial exploitation. Veterans Health Administration (VHA) policy discourages MFH caregivers from managing the financial affairs of their residents, but the veterans appeared to have decision-making capacity and were satisfied with the designation.After determining the MFHs were in violation of VHA policy, the facility revoked VA’s approval for all of Mr. and Mrs. X’s MFHs. However, the facility’s MFH coordinator did not consistently facilitate communication, collaboration, and follow-up, which may have limited joint problem-solving opportunities that would have allowed the MFHs to remain in good standing. VA-approved MFHs must meet state licensure requirements as outlined in Ohio Administrative Code (OAC) Chapter 5122-33 Adult Care Facility (ACF) Regulations. The OAC applies to facilities with 3–16 unrelated adults, at least 3 of whom require personal care. VA-approved MFHs housing only veterans are not required to have an actual state license. Because MFH-1 now has three unrelated adults requiring personal care but does not have official VA MFH designation, it is subject to OAC regulations, which prohibits ACF staff from holding a resident’s POA. According to Ohio regulations, MFH-1 must also secure state licensure to operate legally as an MFH.Although VHA policy was silent on reporting cases of MFH revocation to outside entities, MFH staff had notified state authorities that veterans still resided in MFH-1.