Federal Reports

Medicare Compliance Review of Parkridge Medical Center, Inc., for 2014 and 2015 Parkridge Medical Center, Inc. (the Hospital), located in Chattanooga, Tennessee, complied with Medicare billing requirements for 88 of 100 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 12 claims for the audit period (calendar years 2014 and 2015). On the basis of our sample results, we estimated that the Hospital received overpayments totaling at least $201,808 for the audit period. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess the Units' adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.

Smoking is the leading cause of preventable disease and death in the United States. In 2009, Congress passed the Family Smoking Prevention and Tobacco Control Act, authorizing FDA to begin regulating tobacco products in the United States. It granted FDA comprehensive authority over domestic tobacco products and established the Center for Tobacco Products at FDA to oversee the manufacturing, distribution, and marketing of these products. Our work focuses on FDA's efforts to regulate and oversee domestic tobacco manufacturing establishments in the early years of implementing the Tobacco Control Act.

Please see the link below for a podcast discussing the results of this review.

OIG conducted this audit at the request of Congressman Mike Coffman in response to an allegation that the South Texas Veterans Health Care System (STVHCS) had about 20,000 past due pending radiology orders. To address the allegation, OIG evaluated if STVHCS had past due radiology orders that required action and adversely affected patients’ quality of care. OIG substantiated the allegation that STVHCS Imaging Service had a significant number of past due radiology orders, although fewer than alleged by the complainant. OIG identified 17,790 potentially past due pending orders with a clinically indicated date before January 1, 2016. OIG projected that as of January 5, 2016, STVHCS had 5,500 patients with 7,200 pending past due orders that were not completed or not scheduled for timely completion. Additionally, OIG estimated STVHCS had as many as 9,500 pending orders that should have been canceled. This occurred because STVHCS Imaging Service lacked an effective manual hard copy radiology exam scheduling process, a means of ensuring pending orders were canceled when no longer needed, and procedures to address delays and prevent duplicate orders. The STVHCS Imaging Service’s inability to provide patients with timely radiological care adversely affected the quality of care provided to some patients. The Office of Healthcare Inspection’s clinical reviews confirmed that delays had minor clinical impacts on 14 patients and an intermediate clinical impact on one patient. OIG recommended the STVHCS Director address STVHCS’s current pending radiology order inventory and strengthen radiology exam scheduling, management, and monitoring controls to prevent future delayed exams. In response to this audit, STVHCS reported it had reduced its pending radiology inventory to only 366 orders as of April 19, 2017. The STVHCS Director concurred with OIG's recommendations and provided an action plan to address these recommendations. OIG will monitor the planned actions and follow up on implementation.

OIG conducted a healthcare inspection to assess allegations regarding pressure ulcer prevention and management at the Brooklyn and Manhattan campuses of the VA New York Harbor Healthcare System (system), New York, NY. The timeline of events and allegations were: in 2014, a patient developed pressure ulcers following admission to the system, which were not appropriately managed by clinical staff. Initially, OIG’s Hotline Division requested that the system conduct a review of the complainant’s allegations and submit a response. We determined the response to be insufficient. We subsequently referred the matter to the Veterans Integrated Service Network (VISN) for a response and included specific questions for VISN leadership to address. In 2015, another patient developed pressure ulcers, which were not appropriately managed by clinical staff. In April 2016, we determined the second response regarding Patient A was insufficient and after reviewing a similar complaint from Patient B, we initiated this healthcare inspection. We substantiated that Patient A developed pressure ulcers that subsequently worsened following admission, and clinical staff failed to implement timely and appropriate interventions. We substantiated that Patient B developed pressure ulcers following admission. However, we found that clinical staff timely identified and took steps to address Patient B’s pressure ulcer, which healed prior to his initial discharge from the system. We noted that clinical staff skin care documentation was incomplete and inconsistent for both Patients A and B. To further evaluate the system’s quality of pressure ulcer documentation, we reviewed electronic health records of acute care patients with pressure ulcers who were discharged from December 1, 2015 through May 31, 2016, and January 2017. We identified noncompliance with requirements for pressure ulcer prevention and management-related documentation. Since the time of our onsite visit in late June 2016, some issues with the quality of pressure ulcer documentation persisted.

In early 2017, OIG evaluated the Phoenix VA Regional Office (VARO) to see how Veterans Service Center (VSC) staff processed disability claims, timely and accurately processed proposed rating reductions, input claim information, and responded to special controlled correspondence. Staff didn't consistently process one of the two types of disability claims. OIG reviewed 30 veterans’ traumatic brain injury claims and found staff accurately processed 29 of 30 claims. OIG reviewed 30 special monthly compensation (SMC) benefits claims and found that Rating Veterans Service Representatives incorrectly processed 3 of 30 claims due to a lack of effective oversight. Overall, VSC staff correctly processed 56 of the 60 disability claims OIG reviewed; however, the errors resulted in 73 improper payments to 3 veterans totaling approximately $44,700. OIG reviewed 30 rating reductions cases and found that staff delayed or incorrectly processed 11 cases—resulting in approximately $15,500 in overpayments and $2,400 in underpayments. This was due to prioritization of other workloads. OIG reviewed 30 newly established claims and found staff didn't correctly input claim and claimant information into the electronic systems for 15 claims due to ineffective operational oversight. OIG reviewed 30 special controlled correspondences, finding inaccuracies in 11 cases because of a lack of training and outdated local guidance. Specifically, in nine of the cases, congressional liaisons didn’t upload all of the required documents, such as privacy consent documents, congressional inquiries, or final responses to the veterans’ electronic claims folders. Therefore, Veterans Benefits Administration management and staff would not be able to review issues pertaining to timeliness and accuracy of these documents in the veterans’ electronic claims folders. OIG recommended the Phoenix VARO Director implement plans to improve oversight of SMC decisions; place higher priority on rating reductions; ensure data entered at the time of claims establishment are accurate; and provide training for special controlled correspondence processing. The Director concurred with our recommendations and the planned corrective actions are responsive.