Good morning to all from Washington, DC. Today OIG posts six reports, updates the CIA List and provides news about enforcement actions. As always, you can use the links provided to go directly to the new material. Report Recap What Where How Much Durable Medical Equipment Kansas $4.2 Million Medicaid Family Planning North Carolina $1.4 Million Medicaid Personal Care Services New Mexico $405,000 Medicaid Personal Care Services Louisiana $119,000 ARRA Grant Costs Utah No problems First AME Head Start Program Washington Governance issues ------------------------------------------------------------------------------ Pos-T-Vac Medical Did Not Meet Medicare Documentation Requirements for Over Half of Sampled Claims for Male Vacuum Erection Systems (A-07-11-05016) http://go.usa.gov/vBS Of the 100 sampled claims for vacuum erection systems that were submitted by Pos-T-Vac Medical (Pos-T-Vac), a Medicare durable medical equipment (DME) supplier, and that we reviewed, 51 claims did not comply with Medicare DME documentation requirements. Based on the results of our sample, we estimated that unsupported Pos-T-Vac paid claims for vacuum erection systems resulted in overpayments totaling $4.2 million during the period January 1, 2008, through December 31, 2009. For 50 claims, Pos-T-Vac did not maintain proof of delivery in its files; for 2 claims, Pos-T-Vac did not maintain sufficient documentation of the patients’ medical condition to substantiate the necessity for the items ordered; and for 1 claim, the physician’s written order lacked the signature of the treating physician (2 claims were missing more than 1 piece of required documentation). Pos-T-Vac submitted unsupported claims because it lacked adequate internal controls to ensure that it collected and maintained the required documentation. We recommended that Pos-T-Vac: (1) Refund $4.2 million to the Federal Government and (2) Develop and implement policies and procedures to help ensure that it collects and maintains the required documentation. Pos-T-Vac did not concur with our finding regarding proof of delivery but concurred with our other findings. ------------------------------------------------------------------------------ North Carolina Incorrectly Claimed Enhanced Federal Reimbursement for Some Medicaid Services That Were Not Family Planning (A-04-10-01089) http://go.usa.gov/vKi North Carolina did not always claim Medicaid family planning reimbursement in accordance with Federal and State requirements. Based on our sample results, we estimated that the State improperly claimed $1.4 million (Federal share) in Medicaid reimbursement for pharmacy claims from October 1, 2004, through September 30, 2007. The Social Security Act requires States to furnish family planning services and supplies to individuals of childbearing age who are eligible under the State Medicaid plan and who desire such services and supplies. The amount of funding that the Federal Government reimburses to State Medicaid agencies, known as the Federal share, is determined by the Federal medical assistance percentage (FMAP). The Federal Government is authorized to reimburse States for expenditures in family planning services at an FMAP of 90 percent (enhanced rate). Of 104 pharmacy claims in our stratified random sample, 21 claims did not meet requirements. Of 126 sterilization and clinic and practitioner claims that we reviewed in our judgmental sample, 3 sterilization claims did not qualify for reimbursement at the enhanced rate because the claims were not supported by consent forms that met Federal requirements. The State made these improper claims because it did not have adequate controls to ensure that it claimed only Medicaid family planning services at the enhanced rate. We recommended that the State: (1) Refund $1.4 million to the Federal Government for non-family-planning pharmacy claims that were reimbursed at the enhanced rate, (2) Refund $4,000 to the Federal Government for non-family-planning sterilization claims that were reimbursed at the enhanced rate, (3) Improve controls to ensure that the State claims the enhanced rate only for contraceptive drugs that physicians prescribe for family planning purposes, (4) Reemphasize to providers that only services clearly provided for family planning purposes should be billed as family planning, and (5) Improve controls to ensure sterilization consent forms are completed in accordance with Federal regulations. The State concurred with our second recommendation but generally did not concur with the remaining recommendations. ------------------------------------------------------------------------------ Review of New Mexico Medicaid Personal Care Services Provided by Clovis Homecare, Inc. (A-06-09-00117) http://go.usa.gov/vKO For the period October 1, 2008, to March 31, 2009, we estimated that New Mexico paid Clovis Homecare, Inc. (Clovis), at least $405,000 for personal care services claims that did not always comply with certain Federal and State requirements. Of the 100 claims in our random sample, 24 did not comply with these requirements. The deficiencies included inadequate attendant certifications, no documentation of supervisory visits, unsupported units of service claimed, no documentation of physician authorization, and lack of State agency approval for personal care services provided by the recipient’s legal guardian or attorney-in-fact. We recommended that the State agency: (1) Refund to the Federal Government the $405,000 paid to Clovis for unallowable personal care services and (2) Ensure that personal care services providers maintain evidence that they comply with Federal and State requirements. Clovis disagreed with most of our findings, and the State agency disagreed with our recommended refund amount paid to Clovis for improper claims submitted for the audit period. ------------------------------------------------------------------------------ Review of Louisiana Medicaid Personal Care Services Provided by American Pride Caregivers, LLC (A-06-09-00107) http://go.usa.gov/vKx For the period October 1, 2006, through March 31, 2009, the Louisiana Department of Health and Hospitals, Bureau of Health Services Financing (the State agency), did not always ensure that American Pride Caregivers, LLC’s (American Pride), claims for Federal reimbursement of Medicaid personal care services complied with certain Federal and State requirements. Of the 100 claims in our random sample, 86 did not comply with these requirements. As a result, American Pride received at least $119,000 of unallowable reimbursement. ------------------------------------------------------------------------------ The University of Utah Claimed Allowable Costs Under American Recovery and Reinvestment Act of 2009 Grant Numbers 1RC2LM010798-01 and 5RC2LM010798-02 (A-07-11-06025) http://go.usa.gov/vKC The University of Utah’s claimed costs of $1,360,000 under the American Recovery and Reinvestment Act of 2009 were allowable under the terms of the National Institutes of Health grants and applicable Federal regulations. ------------------------------------------------------------------------------ First A.M.E. Child Development Center’s Head Start Program Governance Was Not Fully in Accordance With Federal Requirements (A-09-11-01003) http://go.usa.gov/vK1 Located in Seattle, WA, the First A.M.E. Child Development Center’s (the Center) Head Start program governance was not fully in accordance with Federal requirements. A majority of board members, including the licensed attorney, did not attend all of the board of directors meetings. Because of the board members’ lack of participation, the governing body may not have ensured active and informed governance of the Center or fully participated in the development, planning, and evaluation of the Center’s Head Start programs. The American Recovery and Reinvestment Act of 2009 (Recovery Act) provided an additional $2.1 billion for the Head Start program during fiscal years 2009 and 2010. On July 1, 2009, the Center received $149,000 in Recovery Act funding. ------------------------------------------------------------------------------ Corporate Integrity Agreement (CIA) List Update http://go.usa.gov/vK2 CIA with Steven Spillers, M.D. added to the list today. ------------------------------------------------------------------------------ June 15, 2012; U.S. Attorney; Central District of California Rancho Palos Verdes Doctor Agrees to Pay $530,000 to Settle Civil Lawsuit Alleging Home Health Kickback Scheme http://go.usa.gov/yWn ------------------------------------------------------------------------------ State Enforcement Actions Updated http://go.usa.gov/pqp ------------------------------------------------------------------------------ That’s all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov Make it a great day! Marc Wolfson – Office of External Affairs OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp
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OIG Posts 6 Reports, Updates CIA List, and Provides News about Enforcement Actions - 6/19
