Good morning to all from Washington, DC. Today OIG posts two reports & an advisory opinion, updates the List of Excluded Individuals and Entities ((LEIE) database, and provides news about enforcement actions. As always, you can use the links provided to go directly to the new material. ------------------------------------------------------------------------------ CMS Reporting to the Healthcare Integrity and Protection Data Bank (OEI-07-09-00292) http://go.usa.gov/rAYH WHY WE DID THIS STUDY In a 2010 report entitled CMS Reporting to the Healthcare Integrity and Protection Data Bank (OEI 07 09 00290), OIG found that CMS took adverse actions against providers but did not report all of these actions to the Healthcare Integrity and Protection Data Bank (HIPDB) as required. For example, none of the adverse actions against durable medical equipment (DME) suppliers taken during 2008 had been reported to the HIPDB as of April 30, 2009. In the 2010 report, OIG recommended—and CMS concurred—that CMS should report all adverse actions as required. This memorandum report provides an assessment of CMS’s reporting to the HIPDB approximately 2 years after the release of the initial report. HOW WE DID THIS STUDY We obtained a copy of the data in the HIPDB as of April 1, 2012. We compared these HIPDB data (e.g., the number, frequency, and types of adverse actions reported by CMS) with the data obtained for our 2010 report. By comparing the data from April 1, 2012, with those from April 30, 2009, we were able to make conclusions about the extent to which CMS’s reporting to the HIPDB addresses our 2010 report recommendation. WHAT WE FOUND CMS improved its reporting of adverse actions for DME suppliers, but not for other types of providers. CMS has not fully addressed our 2010 report recommendation to report required adverse actions to the HIPDB or to report such actions within required timeframes. WHAT WE CONCLUDE Based on the results of our review, our 2010 recommendation that CMS should report all adverse actions as required remains open.
------------------------------------------------------------------------------ Medicare Overpaid Inpatient Rehabilitation Facilities Millions of Dollars for Claims with Late Patient Assessment Instruments for Calendar Years 2009 and 2010 (A-01-11-00534) http://go.usa.gov/rAYh Under the prospective payment system for inpatient rehabilitation facilities (IRF), the Centers for Medicare & Medicaid Services (CMS) establishes a prospective payment rate for each of 92 distinct case-mix groups. IRFs must electronically transmit a patient assessment instrument (PAI) for each IRF stay to the National Assessment Collection Database (the Database). If an IRF transmits the PAI more than 27 calendar days from (and including) the beneficiary’s discharge date, the IRF’s payment rate for the applicable case-mix group incurs a 25-percent late-assessment penalty. Based on our sample results, we estimated that Medicare Administrative Contractors (MAC) made a total of $8.4 million in overpayments to IRFs because IRFs often did not receive reduced case-mix-group payments for claims with PAIs that were transmitted to the Database after the 27-day deadline. Of the 108 claims that we sampled, which had dates of service in calendar years 2009 and 2010, 20 were either canceled or paid correctly. For the remaining 88 claims, IRFs did not receive reduced case-mix-group payments for PAIs that were transmitted to the Database after the 27-day deadline. The overpayments occurred because IRF and Medicare payment controls were inadequate. We recommended that CMS: (1) Adjust the 88 sampled claims for overpayments of $696,000 to the extent allowed under the law; (2) Work with the Office of Inspector General to resolve the remaining 2,306 non-sampled claims with potential overpayments estimated at $7.7 million and recover overpayments to the extent allowed under the law; (3) Continue to provide specific education to IRFs on the importance of reporting the correct PAI transmission dates on their claims; (4) Complete the process that would allow the Fiscal Intermediary Shared System to interface with the Database to identify, on a prepayment basis, IRF claims with incorrect PAI transmission dates; and 5) Support the MACs’ and Recovery Audit Contractors’ efforts to conduct periodic post payment reviews of IRF claims. CMS concurred with our findings and recommendations and outlined steps for implementing our recommendations. ------------------------------------------------------------------------------ Advisory Opinion 12-12 http://go.usa.gov/rAgP This advisory opinion concerns a proposed bundle billing arrangement for basic life support advanced life support joint responses. ------------------------------------------------------------------------------ LEIE Database Updated with August 2012 Exclusions and Reinstatements The "Updated LEIE" database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in August 2012. This new, "Updated LEIE" (List of Excluded Individuals and Entities) is a complete database file containing all exclusions currently in effect. Individuals and entities that have been reinstated to the Federal health care programs are not included in this file. The new file is meant to REPLACE the "Updated LEIE" file made available for download last month. The new file is complete and need NOT be used in conjunction with the monthly exclusion and reinstatement supplements. Alternatively you may wish to download either the August Exclusions or Reinstatements databases only which are posted as the "Current Monthly Supplements" All the updated files are posted at http://www.oig.hhs.gov/exclusions/exclusions_list.asp All of these downloadable files are zipped, self-extracting .dbf files, meaning that they will not open automatically when you click on the links. After you have downloaded the files to your computer and inflated them, the files must be opened into either a spreadsheet program such as Excel, or a database program such as Access. Basic download instructions are provided at the bottom of the page where the updated files are posted. Finally, it should be added, the full LEIE database -- complete with all the monthly updates -- is included in the OIG "Online Searchable Database" which is very user-friendly and may be accessed here: ------------------------------------------------------------------------------ September 12, 2012; U.S. Attorney; Southern District of Texas Edinburg Woman Sentenced for Mail Fraud 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 2 reports, an advisory opinion, updates the LEIE database and provides news about enforcement actions - 9/13
