Delores L. Galias, RN, RHIT
STATEMENT OF CONFIDENTIALITY:
The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify D. Galias, RN, RHIT immediately at [EMAIL PROTECTED] and destroy all copies of this message and any attachments. Thank you for your cooperation
--- Begin Message ---Hello To All, OIG has posted a notice from today's Federal Register on its website.To get to the item, "Annual Solicitation of New Safe Harbors and Special Fraud Alerts in Accordance with Section 205 of the Health Insurance Portability and Accountability Act (68 FR 69366)" go here: http://oig.hhs.gov/authorities/docs/121203FRnotice.pdf Note: The OIG notice starts in the third column about two-thirds of the way down on page 69366. _______________ OIG has also posted one new Inspection and one new Audit report to the. Summaries of the reports follow. Selecting the link immediately following the title will take you directly to the full document. INSPECTION REPORT: Trends in the Assignment of Resource Utilization Groups (OEI-01-03-00180) http://oig.hhs.gov/oei/reports/oei-01-03-00180.pdf In 1998 Medicare began to reimburse skilled nursing facilities using a prospective payment system. In order to determine reimbursement, nursing homes code Medicare residents into 1 of 44 resource utilization groups (RUGs). In 1999, the Balanced Budget Reform Act included a 4 percent across-the-board increase in payments to skilled nursing facilities for fiscal years 2001 and 2002 and a temporary 20 percent increase to 15 RUGs for resident conditions considered medically complex. In the fall of 2000, Congress further adjusted the payment rates under the Benefits Improvement and Protection Act, which also mandated that the Office of Inspector General assess whether payment incentives exist for the delivery of inadequate care. Based on OIG analysis of data from January 1999 to December 2002, minimal shifts occurred in the assignment of resource utilization groups that correspond to legislative payment changes to skilled nursing facilities during this period. As of October 1, 20! 02, all temporary payment adjustments ended, and any payment incentives that may have existed concluded at that time. _______________ AUDIT REPORT Review of the Commonwealth of Pennsylvania's Medicaid Behavioral HealthChoices Program for State Fiscal Years Ending June 30, 2001 and June 30, 2002 (A-03-03-00200) http://oig.hhs.gov/oas/reports/region3/30300200.pdf Pennsylvania contracts with its counties to provide behavioral health services through the Medicaid managed care program, HealthChoices. The Centers for Medicare and Medicaid Services (CMS) approved the HealthChoices program under a waiver granted under section 1915(b) of the Social Security Act and allows counties the right of first opportunity to provide behavioral health services without a competitive bid process. For the State fiscal year ending June 30, 2001, there were 15 counties in the program. The following year, the program expanded to 25 counties (of 67) and includes most of Pennsylvania's major population centers. While aggregate profits were reasonable, we found that several counties realized profits that appeared unreasonable, some as high as 38 percent. We also found that Pennsylvania was not including these profits in its base year administrative costs as now required by CMS when submitting its rate requests. We recommended that CMS require the inclusio! n of county-specific profit and/or losses into its base year administrative costs to allow them to compare the proposed rates to the base year data to assure that the rates are reasonable. _______________ Well folks, that's all for now. As always, if we can provide you with further information or assistance please don't hesitate to let us know either by email ([EMAIL PROTECTED]) or by phone (202/619-1343) how we can help. Hope you have a great pre-holiday weekend! -- Don White, Public Affairs ______________________________ The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) protects the integrity of HHS programs from fraud, waste and abuse through its nationwide network of auditors, investigators and analysts. In FY 2003, OIG saved taxpayers a record $23 billion, excluded 3,275 people and companies from Medicare/Medicaid reimbursement, secured 576 criminal convictions and 243 civil actions.
--- End Message ---
