Reports

Department of Health & Human Services OIG

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency

Audit | 5/02/2023

23-A-09-068.01 - Open

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to recover $35,560 in improper payments made to providers for the 128 sampled enrollee days that did not meet Medicare requirements.

23-A-09-068.02 - Closed

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to based upon the results of this audit, notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

23-A-09-068.03 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Conduct medical reviews of psychotherapy services, including services provided via telehealth, to verify that the services are documented and billed in accordance with Medicare requirements.

23-A-09-068.04 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Implement system edits for psychotherapy services, including services provided via telehealth, to prevent payments for services that were billed incorrectly.

23-A-09-068.05 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Strengthen educational efforts to make providers aware of educational materials on how to meet Medicare requirements and guidance for psychotherapy services, including services provided via telehealth.

23-A-09-068.06 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS work with the MACs to take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Review MAC jurisdictions' LCD requirements for psychotherapy services to identify which provisions effectively promote program integrity, and consider additional steps that CMS could undertake to ensure appropriate coverage and payment for psychotherapy services across all jurisdictions.

Department of Health & Human Services OIG

Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19

Full Details: Oversight.gov Report Page

Audit | 12/21/2022

Department of Health & Human Services OIG

IHS Did Not Always Provide the Necessary Resources and Assistance To Help Ensure That Tribal Programs Complied With All Requirements During Early COVID-19 Vaccination Program Implementation

Full Details: Oversight.gov Report Page

Audit | 10/17/2022

Department of Justice OIG

Audit of the Management and Coordination of Pandemic-Related Fraud Allegations and Referrals Between the Criminal Division and Executive Office for U.S. Attorneys

To view a message from the Inspector General, click here: https://oig.justice.gov/news/multimedia/video/message-inspector-general…

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

An Estimated 91 Percent of Nursing Home Staff Nationwide Received the Required COVID-19 Vaccine Doses, and an Estimated 56 Percent of Staff Nationwide Received a Booster Dose

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

National Snapshot of Trends in the National Domestic Violence Hotline's Contact Data Before and During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

The Assistant Secretary for Administration Awarded and Managed Five Sole Source Contracts for COVID-19 Testing in Accordance With Federal and Contract Requirements

The Department of Health and Human Services (HHS) is one of the largest contracting agencies in the Federal Government. In fiscal year 2020, HHS awarded over $14 billion in contracts in response to the COVID-19 pandemic. Of these contracts, HHS's Assistant Secretary for Administration (ASA) awarded five sole source COVID-19 testing contracts to national pharmacy and grocery retail chains to provide Americans convenient access to COVID-19 testing at testing site locations throughout the United States. The contracts provided a flat-fee payment to participating retailers for each test...

Full Details: Oversight.gov Report Page

Department of Justice OIG

Review of the Office of Justice Programs’ Administration of CARES Act Funding

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data

The United States currently faces a nationwide public health emergency because of the COVID-19 pandemic. Federal regulations, effective May 8, 2020, required nursing homes to report COVID-19 information, such as the number of confirmed COVID-19 cases among residents, at least weekly to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network. Each week, CDC aggregates the reported information and sends the data to the Centers for Medicare & Medicaid Services (CMS) for posting to the CMS website. These data are used to assist with national surveillance of...

Full Details: Oversight.gov Report Page

Audit | 9/01/2021

271069 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to develop a process to identify nursing homes that do not report required data for all of the data elements related to COVID-19 cases and deaths among residents and staff and PPE and supplies and request that they submit the required data.

271070 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to revise its quality assurance checks for ratios 1, 3, 5, and 6, which use the number of all beds in the denominator, to ensure that it does not exclude from its COVID-19 data nursing homes' data that should be included.

271071 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to revise its quality assurance checks for ratios 2 and 4, which use the numbers of confirmed cases and admissions among residents and confirmed cases among staff in the denominator, by adding the number of suspected COVID-19 cases to the denominator in both ratios and adjust the ratios' thresholds to reflect the change.

271072 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to identify the nursing homes that reported more total COVID-19 deaths than total deaths from any cause and request that they verify or correct the reported data.

271073 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to contact nursing homes that failed quality assurance checks to verify the accuracy of reported data or to correct inaccurate data.

271074 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to work with CDC and with State health departments to determine the feasibility of using comparable data elements to collect COVID-19 data and the feasibility of monitoring substantial differences in the data and, if determined feasible, take actions to provide the public with more complete and accurate COVID-19 data for nursing homes.

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Reports

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency

Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19

IHS Did Not Always Provide the Necessary Resources and Assistance To Help Ensure That Tribal Programs Complied With All Requirements During Early COVID-19 Vaccination Program Implementation

Audit of the Management and Coordination of Pandemic-Related Fraud Allegations and Referrals Between the Criminal Division and Executive Office for U.S. Attorneys

An Estimated 91 Percent of Nursing Home Staff Nationwide Received the Required COVID-19 Vaccine Doses, and an Estimated 56 Percent of Staff Nationwide Received a Booster Dose

National Snapshot of Trends in the National Domestic Violence Hotline's Contact Data Before and During the COVID-19 Pandemic

The Assistant Secretary for Administration Awarded and Managed Five Sole Source Contracts for COVID-19 Testing in Accordance With Federal and Contract Requirements

Review of the Office of Justice Programs’ Administration of CARES Act Funding

Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic

CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data

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