Federal Reports

Members of Congress and others have raised concerns about the high prices of certain drugs and the impact these high prices have on Medicare beneficiaries and the health care system. An important part of the Medicare Part D benefit is catastrophic coverage, which beneficiaries enter when their out-of-pocket costs exceed a certain threshold. In catastrophic coverage, most beneficiaries pay a 5-percent coinsurance for drugs, while the Federal Government pays the vast majority of the remaining costs. Understanding the effect that high drug prices have on spending in catastrophic coverage is crucial. In catastrophic coverage, beneficiaries' out-of-pocket costs are not capped, and the Federal Government's share of drug spending is the highest.

For Fiscal Year (FY) 2016, the U.S. Equal Employment Opportunity Commission (EEOC), Office of Inspector General (OIG) contracted with Brown & Company CPAs and Management Consultants, PLLC (Brown & Company) to conduct an independent evaluation of EEOC’s compliance with the provisions of the Federal Information Security Modernization Act of 2014 (FISMA). FISMA requires agencies to develop, document, and implement an agency-wide information security program to provide information security for the information and information systems that support the operations and assets of the agency, including those provided or managed by another agency, contractor, or other source.Based on the results of our evaluation, Brown & Company concluded that the EEOC continues to make positive strides in addressing information security weaknesses; however, the agency still faces challenges to fully implement information security requirements as stipulated in various federal guidelines and mandates.

During the period April 1, 2013, through March 31, 2014, the Louisiana Department of Health and Hospitals (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services claims submitted by transportation providers that did not comply with certain Federal and State requirements. Of the 120 NEMT claims in our sample, the State agency properly claimed Medicaid reimbursement for 83 claims. However, the remaining 37 claims contained services that did not comply with certain Federal and State regulations. Of the 37 claims, 14 contained more than 1 deficiency.

Qualified aliens are generally not permitted to receive Federal Medicaid benefits for 5 years from the date they enter the United States with qualified alien status. States are required to have a verification system to meet requirements for receiving Federal reimbursement for services provided to qualified aliens. To comply with those requirements, the California Department of Health Care Services (State agency) created the quarterly alien claiming adjustment report (adjustment report) in its Medicaid Management Information System (MMIS) to identify claims for services provided to qualified aliens who had not met, and were not otherwise excepted from, the 5-year waiting period.