Federal Reports

EAC OIG, through the independent public accounting firm of McBride, Lock & Associates LLC, audited the use of funds under the Help America Vote Act by the New Hampshire Secretary of State.

Several of the Consumer Operated and Oriented Plans (CO-OPs) that were operating at the beginning of 2016 are no longer viable or sustainable. Specifically, 5 of the 11 CO-OPs operating on January 1, 2016, had ceased or planned to cease operations by the end of the 2016 plan year, and each of the remaining 6 CO-OPs reported net losses and had drawn down nearly all available CO-OP loan amounts as of December 31, 2016. These six operational CO-OPs did not appear to be financially viable and sustainable based on the reported net income and available capital and surplus. When a CO-OP ceases operations during the plan year, health plan participants can be significantly affected.

Medicare Part B paid for some immunosuppressive drugs billed with the KX modifier that were not eligible for Part B payment. Of the 75 claims in our random sample, pharmacies had documentation to support the KX modifier for 65 claims but did not have support for the remaining 10.

In February and March 2017, we evaluated the Philadelphia, PA, VA Regional Office (VARO) to determine how well Veterans Service Center (VSC) staff processed veterans’ disability claims, how timely and accurately they processed proposed rating reductions, how accurately they entered claims-related information, and how well they responded to special controlled correspondence. VSC staff did not consistently process some of the disability claims we reviewed. OIG reviewed 30 veterans’ traumatic brain injury claims and found Rating Veterans Service Representatives (RVSRs) accurately processed 27. This represented a significant improvement from our 2013 inspection. RVSRs did not always process entitlement to special monthly compensation (SMC) and ancillary benefits consistent with Veterans Benefits Administration (VBA) policy. OIG reviewed 30 claims involving entitlement to SMC and related ancillary benefits and found RVSRs incorrectly processed 13, resulting in 189 improper monthly payments to 10 veterans totaling approximately $123,000. This occurred because of an ineffective second signature review process. VSC staff generally processed proposed rating reductions accurately. OIG reviewed 30 rating reduction cases and found staff delayed or incorrectly processed 10 because management placed higher priority on other workload. OIG reviewed 30 newly established claims and found staff did not correctly input claim and claimant information into the electronic systems at the time of claims establishment in 15 because of lack of training and staff rushing to establish claims. VSC staff processed special controlled correspondence timely but needed to improve accuracy. OIG reviewed 30 special controlled correspondences and found staff incorrectly processed 13 because of lack of training and inadequate oversight by management. OIG recommended the VARO Director develop and implement a plan to assess the accuracy of secondary reviews involving higher level SMC, ensure oversight of rating reductions, monitor the effectiveness of claims establishment training, and develop a plan to monitor the effectiveness of training and reviews of special controlled correspondence. The VARO Director concurred with our recommendations and planned actions are responsive.

CNCS-OIG investigators found no evidence to support an allegation that AmeriCorps members with the Volunteers in Service to America, Student Veterans of America, Washington, DC, a service site of the American Legion Auxiliary, Indianapolis, IN., engaged in prohibited activities to influence proposed legislation.