Federal Reports

The President's Emergency Plan for AIDS Relief (PEPFAR) was authorized to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Additional funds were authorized to be appropriated through 2018.

Sixty-one percent of Medicare claims for outpatient physical therapy services that we reviewed did not comply with Medicare medical necessity, coding, or documentation requirements. Specifically, of the 300 claims in our stratified random sample, therapists claimed $12,741 in Medicare reimbursement on 184 claims that did not comply with Medicare requirements. Therapists properly claimed Medicare reimbursement on the remaining 116 claims. On the basis of our sample results, we estimated that during the 6-month audit period, Medicare paid $367 million for outpatient physical therapy services that did not comply with Medicare requirements. These overpayments occurred because the Centers for Medicare & Medicaid Services' controls were not effective in preventing unallowable payments for outpatient physical therapy services.

The OIG investigated allegations that a Bureau of Indian Affairs (BIA) senior official approved or directed the approval of two drawdowns totaling approximately $3.1 million from an Operation, Maintenance, and Replacement (OMR) Trust Fund designated for a regional rural water system (RWS) at a time when the RWS was years from completion and had few, if any, OMR expenses. There was increased scrutiny of the senior official’s involvement because he was affiliated with a group that would be served by the RWS.Our investigation determined that a subordinate of the senior official, not the senior official, authorized the drawdowns. The senior official had recused himself from the matter and had no involvement in either drawdown.We also found that the subordinate failed to perform required due diligence before approving the drawdowns. After questions arose following the first drawdown, the subordinate of the senior official was directed to consult with BIA’s Office of Facilities Management and Construction (OFMC) prior to any future drawdowns, however, he failed to consult with OFMC prior to the second drawdown. The subordinate acknowledged he failed to perform the required due diligence and retired from the BIA before the completion of our investigation.The United States Attorney’s Office for the District of Montana declined prosecution.