From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Tue, Jul 15, 2014 at 8:30 AM
Subject: OIG posts 3 reports, position vacancy and news about enforcement actions - 7/15
To: iammejtm@gmail.com
Good morning from Washington, DC. Today OIG posts 3 reports, a position vacancy and news about enforcement actions. As always, you can use the links provided to go directly to the new material.
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New Jersey Did Not Comply With Recovery Act Requirements for Receiving Increased Federal Medicaid Assistance (A-02-11-01039) http://go.usa.gov/XznC
Under the American Recovery and Reinvestment Act of 2009 (Recovery Act), States were eligible for a temporary increase in Federal medical assistance percentage (FMAP) only if they did not require political subdivisions (e.g., counties and local school districts) to pay a greater percentage of the non-Federal share of Medicaid expenditures during the recession-adjustment period (October 1, 2008, through December 31, 2010) than the percentage required under the State Medicaid plan during the 12-month period ended September 30, 2008 (base period).
New Jersey did not comply with the political subdivision requirement for receiving the increased FMAP under the Recovery Act. In the aggregate, New Jersey's political subdivisions contributed 4.84 percent of the non-Federal share of Medicaid expenditures during the base period and 6.35 percent of the same share during the recession-adjustment period—a difference of 1.51 percent. We calculated that New Jersey could demonstrate compliance with the political subdivision requirement if it redistributed approximately $45.2 million to its political subdivisions.
New Jersey's political subdivisions contributed a greater percentage of the non-Federal share of Medicaid expenditures during the recession-adjustment period than during the base period because the New Jersey Department of Human Services (State agency) did not adjust its requirements for these contributions to ensure compliance with the political subdivision requirement before the State agency accessed increased FMAP funds.
We recommended that the State agency:
(1) Redistribute approximately $45.2 million in increased FMAP funding to its political subdivisions to comply with the political subdivision requirement and
(2) Work with CMS to ensure that, for the 6-month Recovery Act extension period ended June 30, 2011, political subdivisions did not contribute a greater percentage of the non-Federal share of Medicaid expenditures than the percentage required under the State Medicaid plan on September 30, 2008. ------------------------------------------------------------------------------
New York Claimed Nonhospital-Based Continuing Day Treatment Services That Were Not in Compliance With Federal and State Requirements (A-02-12-01011) http://go.usa.gov/XzNh
The New York State Department of Health (State agency) claimed Federal Medicaid reimbursement for nonhospital continuing day treatment (CDT) services claims that did not comply with Federal and State requirements. Of the 100 claims in our random sample, 66 claims complied with Federal and State requirements, but 34 claims did not.
The deficiencies occurred because:
(1) Certain nonhospital CDT providers did not comply with Federal and State regulations and
(2) The State agency did not ensure that OMH adequately monitored the CDT program for compliance with certain Federal and State requirements.
On the basis of our sample results, we estimated that the State agency improperly claimed at least $18.1 million in Federal Medicaid reimbursement for nonhospital CDT services that did not meet Federal and State requirements.
We recommended that the State agency:
(1) Refund $18.1 million to the Federal Government,
(2) Work with the State's Office of Mental Health (OMH) to issue guidance to the provider community regarding Federal and State requirements for claiming Medicaid reimbursement for nonhospital CDT services, and
(3) Work with OMH to improve OMH's monitoring of the CDT program to ensure compliance with Federal and State requirements.
The State agency disagreed with our first recommendation (financial disallowance) and did not indicate concurrence or nonconcurrence with our remaining recommendations.
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Not All of Kansas's Controls for Its Child Care Subsidy Program Claims Were Effective (A-07-12-03182) http://go.usa.gov/XzQJ
The Kansas Department for Children and Families' (State agency) controls for claims processing and for client eligibility determinations were not always effective. Of the claims processing controls we tested, the State agency's controls for preventing payment to providers that had not maintained adequate client attendance records were not effective. However, the State agency's controls for preventing payment to providers who were caring for their own children, for preventing payment to providers in excess of amounts established by the State, and for documenting supervisor approval of excess rates and excess units were effective. Of the client eligibility controls we tested, the State agency's controls for verifying client age and client citizenship were not effective because the controls relied largely on self-declarations by applicants of citizenship and age eligibility. The State agency's controls for verifying family income and for verifying need-for-service eligibility were effective. All of the State agency's controls for provider eligibility that we tested were effective. We tested the controls for the performance of provider background checks, for the maintenance of required provider forms, and for the completion of provider rate agreements.
The State agency required the applicant to declare his/her citizenship and age. Unless the information provided in the application about citizenship status or age was questionable, State policy required the agency to accept the applicant's statement. Eligibility policies for citizenship and age that rely on self-declarations and do not require that an applicant present documentary evidence present a greater potential for false claims. Moreover, the State agency did not exercise sufficient oversight over claims processing because it did not ensure that providers maintained attendance records to support childcare claims payments. Without sufficient written policies and procedures and oversight, the State agency's Child Care Subsidy program is vulnerable to fraud, waste, and abuse.
Of the 100 claims reviewed, we determined that 75 claims showed evidence of ineffective controls for claims processing and for client eligibility. We estimated that $40.9 million ($26.1 million Federal share) of the Child Care Subsidy program claims could have had one or more of the control deficiencies we identified. These deficiencies left the Child Care Subsidy program vulnerable to fraud, waste, and abuse.
We recommended that the State agency improve its controls for client eligibility determinations and for claims processing to ensure that payments for the Child Care Subsidy program are made for eligible clients. Specifically, the State agency should take steps to:
(1) Ensure that providers maintain accurate attendance records to support the childcare payment amounts that they claim for reimbursement by the State agency,
(2) Require that citizenship and qualified alien status of all applicants be verified and documentation of that verification be maintained in all case files, and
(3) Require that the age of all clients be verified and documentation of that verification be maintained in all case files.
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Office of Audit Services: Mathematical Statistician Opening In Washington, D.C.
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Updated Civil Monetary Penalties
Patient Dumping http://go.usa.gov/Xzph
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State Enforcement Actions Updated http://go.usa.gov/9Srm
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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
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Marc Wolfson – Office of External Affairs
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Jeremy Tobias Matthews
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