Federal Reports

Medicare did not appropriately pay acute-care hospitals any of the $51.6 million for outpatient services that we reviewed. In addition, beneficiaries were held responsible for unnecessary deductibles and coinsurance of $14.4 million paid to the acute-care hospitals for outpatient services. Generally, Medicare should not pay an acute-care hospital for outpatient services provided to an inpatient of another facility, such as a long-term-care hospital. Instead, the services should be provided under arrangements between the two facilities, and Medicare should pay the inpatient facility for all services provided to a beneficiary (as part of the facility's inpatient payment rate).

OHRP receives and responds to alleged violations of protections for human subjects in research conducted or supported by the Department of Health and Human Services (HHS). Employees of research institutions (e.g., researchers or study coordinators) with insider knowledge of the circumstances can help identify noncompliance in human subjects research earlier than other complainants or OHRP oversight activities. Such information allows OHRP to address any noncompliance, hold institutions accountable, minimize risk to human subject volunteers, and ensure public confidence in federally funded research. However, when employees are considering whether to disclose information about potential noncompliance, they may fear reprisal, such as demotion, suspension, or termination. Under certain circumstances, employees at research institutions with HHS-funded grants or contracts may be entitled to relief commonly called "whistleblower protections." Such protections may be available if an HHS contractor, subcontractor, grantee, or subgrantee takes a prohibited employment action (e.g., termination) against an employee for making a "protected disclosure." For complainants who fear reprisal, information regarding whistleblower protections may encourage disclosures of noncompliance.

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Federal regulations require each State to ensure that Medicaid beneficiaries have necessary transportation to and from medical providers. During the period October 1, 2012, through September 30, 2013, the Minnesota Department of Human Services (State agency) claimed at least $6.4 million for payments to nonemergency medical transportation (NEMT) providers. Prior OIG reviews have found that States' claims for NEMT services were not always in accordance with Federal and State requirements.