Federal Reports

For our final report on the evaluation of the budgetary controls over the Census Bureau’s Working Capital Fund, we assessed the controls for building overhead rates and distributing charges to projects, reviewed the appropriateness of the level of fund balances, and evaluated compliance with appropriations law.

Tufts Medical Center (Tufts) (operating in Boston, Massachusetts) complied with Medicare billing requirements for 4 of the 18 inpatient and outpatient claims we reviewed. However, Tufts did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in overpayments of at least $118,000 for calendar years 2011 through 2014. These errors occurred primarily because Tufts staff (1) had inadequate education on inpatient level-of-care criteria and lacked documentation necessary to determine the appropriate level of service and (2) lacked the level of oversight and the coordination between departments to correctly report the device credits it received for warranted or recalled medical devices.

Palmetto Government Benefits Administrator, LLC, understated its Medicare segment pension assets by $2.2 million and TrailBlazer Health Enterprises, LLC, understated its Medicare segment pension assets by $180,000 as of January 1, 2005. Both Palmetto and TrailBlazer were subsidiaries of Blue Cross Blue Shield of South Carolina during our audit period.

Palmetto Government Benefits Administrator, LLC, a subsidiary of Blue Cross Blue Shield South Carolina, claimed unallowable pension costs of $132,000 for Medicare reimbursement for fiscal years 2003 and 2004.