Payments for Ambulatory Surgical Center Services Provided to Beneficiaries in Skilled Nursing Facility Stays Covered Under Medicare Part A

Ambulatory surgical center (ASC) facility services, such as nursing, recovery care, anesthetics, drugs, and other supplies, provided to SNF residents are subject to consolidated billing and must be billed to the SNF rather than Medicare Part B. Physicians’ professional services are statutorily excluded from consolidated billing and may be billed to Medicare Part B.

The nationwide audit covered 20,906 Medicare Part B ASC facility services valued at $7,113,542 with dates of service in calendar years (CY) 2006 through 2008 that matched 14,192 Part A SNF stays and that thus represented potential overpayments. GAO sampled 100 services provided by 88 ASCs.

Full GAO Report

Government Auditing Standards: 2010 Exposure Draft

Image via WikipediaAugust 2010

TO AUDIT OFFICIALS AND OTHERS INTERESTED IN GOVERNMENT AUDITING STANDARDS

GAO invites your comments on the accompanying proposed changes to Government Auditing Standards (GAGAS), commonly known as the “Yellow Book.” This letter describes the process used by GAO for revising GAGAS, summarizes the proposed major changes, discusses proposed effective dates, and provides instructions for submitting comments on the proposed standards.

Process for Revising GAGAS

To help ensure that the standards continue to meet the needs of the audit community and the public it serves, the Comptroller General of the United States appointed the Advisory Council on Government Auditing Standards to review the standards and recommend necessary changes.
The Advisory Council includes experts in financial and performance auditing drawn from federal, state, and local government, the private sector, public accounting, and academia. This exposure draft includes the Advisory Council’s input regarding the proposed changes. We are currently requesting public comments on the proposed revisions in the exposure draft.

Summary of Major Changes

The proposed revision to GAGAS will be the sixth since GAO first issued the standards in 1972. The proposed changes contained in the 2010 Exposure Draft update GAGAS to reflect major developments in the accountability and audit profession and emphasize specific considerations applicable to the government environment.

The major changes in the proposed revision were made to:
•  consolidate and reorganize the foundation and ethical principles for government audits and the standards for use and application of GAGAS (chapters 1 and 2);
•  add a conceptual framework approach for independence (chapter 3);
•  update the financial audit standards to  (1) reflect recent updates to the auditing standards issued by the American Institute of Certified Public Accountants (AICPA), where applicable, (2) more clearly identify the GAGAS requirements and guidance that supplement AICPA requirements for financial audits, and (3) consolidate the financial audit standards into a single chapter (chapter 4);

Enclosure 1 to this letter contains a more comprehensive listing of the major changes.

 Effective Dates

When issued in final form, the 2011 revision will supersede the July 2007 revision of the standards and the guidance provided in Government Auditing Standards: Answers to Independence Standard Questions (GAO-02-870G). The effective date for the 2011 revision of GAGAS will be established when the standards are issued in final form.

 Instructions for Commenting

The draft of the proposed changes to Government Auditing Standards, 2010 Exposure Draft, is only available in electronic format and can be downloaded from GAO’s Yellow Book Web Page at http://www.gao.gov/govaud/ybk01.htm.

We are requesting comments on this draft from audit officials and financial management at all levels of government, the public accounting profession, academia, professional organizations, public interest groups, and other interested parties. To assist you in developing your comments, specific issues are presented in enclosure 2 to this letter.

We encourage you to comment on these issues and any additional issues that you note. Please associate your comments with specific references to question numbers in the enclosure and/or paragraph numbers in the proposed standards and provide your rationale for any suggested changes, along with suggested revised language. Please send your comments electronically to yellowbook@gao.gov no later than November 22, 2010.

If you need additional information please call Michael Hrapsky, Specialist, Auditing Standards, at (202) 512-9535, or Jim Dalkin, Director, at (202) 512-3133.

Sincerely yours,

Jeanette M. Franzel
Managing Director
Financial Management and Assurance
Read Full Report

Review of Tennessee's Substance Abuse Prevention and Treatment Block Grants for Federal Fiscal Years 2003 Through 2008

The Tennessee Department of Mental Health and Developmental Disabilities' (the State agency) controls over the expenditure of its Substance Abuse block grant funds were not always adequate.  Specifically, OIG noted four weaknesses in State agency policies and procedures involving:  (1) Federal reporting, (2) subrecipient monitoring, (3) subrecipient expenditure approval, and (4) maintenance of effort and earmarking.

Read More/Download Report

U.S. GAO - Fiscal Year 2009 Financial Report of the United States Government

Image via Wikipedia

The U.S. Government Accountability Office (GAO) could not render an opinion on the consolidated financial statements of the federal government (other than the Statement of Social Insurance) because of widespread material internal control weaknesses and other limitations.

“While financial management has improved significantly since the government began preparing consolidated financial statements, for the 13th year in a row now shortcomings in three areas again prevented us from expressing an opinion,” said Gene L. Dodaro, Acting Comptroller General of the United States. “I’m referring to serious financial management problems at the Department of Defense (DOD), the federal government’s inability to adequately account for and reconcile intragovernmental activity and balances between agencies, and the ineffective process the federal government uses to prepare the consolidated financial statements.”

Dodaro also cited material weaknesses involving improper payments estimated to be at least $98 billion, information security across government, and tax collection activities. He noted that four major agencies-DOD, the Department of Homeland Security, the Department of State, and NASA-did not get clean opinions.

The material weaknesses discussed in GAO’s audit report hinder the government’s ability to (1) reliably report on many of its assets,liabilities, and costs; (2) accurately measure the full cost as well as the financial and non-financial performance of certain programs and activities; (3) adequately safeguard significant assets and properly record various transactions; and (4) have reliable information to operate efficiently and effectively.

“Long term, the federal government faces huge structural deficits driven by rising health care costs and demographics. Focused attention from Congress and the administration is needed to address these problems and put the government on a more sustainable path,” Dodaro said.

Beginning this year, new financial reporting standards will require a clearer and more comprehensive assessment of the federal government’s financial condition over the long term. “Sound data on federal operations will be essential to the nation’s efforts to return the country to a sustainable fiscal path,” Dodaro said.

He also singled out meaningful financial regulatory reform as especially urgent. “Problems in the nation’s financial sector have exposed major weaknesses in the current U.S. financial regulatory system. If those weaknesses are not adequately addressed, we could see similar or even worse crises in the future,” Dodaro cautioned.

Dodaro commended the commitment and professionalism of the Inspectors General across government who are responsible for auditing the annual financial statements of individual federal entities each year.

Link to Report

DHHS OIG FY2010 Work Plan

Image via Wikipedia

This publication describes activities that OIG plans to initiate or continue with respect to the programs and operations of the Department of Health and Human Services (HHS) in the next year.

In this Work Plan, the ongoing and planned reviews are grouped into two major parts:

• “Centers for Medicare & Medicaid Services” (CMS) describes reviews related to Medicare, Medicaid, information systems controls, the Childrens Health Insurance Program, and related investigations and legal counsel to OIG.

• “Public Health and Human Services Programs and Departmentwide Issues” describes reviews related to agencies such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Administration on Aging (AoA), and the Administration for Children and Families (ACF). This part also describes departmentwide issues, such as financial accounting and information systems management.

Our planned reviews related to the American Recovery and Reinvestment Act of 2009 (Recovery Act) are provided in Appendix A of this document.

Read/Download Work Plan

Related articles by Zemanta

• OIG Work Plan Includes Medicare Issues for Skilled Nursing Facilities (medicareupdate.typepad.com)

Ohio Medicaid Long- Term-Care Payments to Two Providers for the Same Beneficiaries for the Same Dates of Services

The DHHS Office of the Inspector General conducted an audit of the Ohio Medicaid long-term care payments for the period October 1, 1998 through September 30, 2005. During the audit period, the State agency paid $70,644,566 ($41,157,524 Federal share) to 3,100 long-term-care providers (1,550 provider pairs) for services provided to the same beneficiaries for the same dates of service. The State agency should not have paid two different providers for services provided to the same beneficiares for the same dates of service unless one of the providers fuished services that were not reimbursed through the long-term-care daily rate. Of a judgmental sample of 100 providers (50 pairs claiming services for the same beneficiaries for the same dates of service) that were paid $38,783,184 ($22,595,083 Federal share), the Statefor the same dates of State agency appropriately claimed $20,699,649 ($12,059,616 Federal share) and paid 52 providers for long-term-care services. However, the State agency nappropriately claimed $18,083,535 ($10,535,467 Federal share) and paid 48 providers that did not provide medical assistance to Medicaid beneficiaries. Of the unallowable payments totaling $18,083,535 ($10,535,467 Federal share), the State agency, as of the start of our audit in July 2007, reported and refunded $8,446,697 ($4,921,045 Federal share) through adjustments decreasing its Medicaid claims for prior quarters on the CMS-64 for the quarter ended June 30, 2005, and had not reported and refunded $9,636,838 ($5,614,422 Federal share). The State agency made the unallowable payments because it did not implement controls within its automated payment system to identify payments to two providers for services claimed for the same beneficiaries for the same dates of service. In addition, the State agency’s policies and procedures for reporting and refunding previous overpayments on the CMS-64 did not ensure the identification of all the unallowable payments.

DHHS OIG Work Plan - FY2009

This document contains the Fiscal Year 2009 work plan for the DHHS Office of Inspector General. For each DHHS agency (AoA, ACF, AHRQ, CDC, CMS, NIH, SAMHSA, etc), the work plan identifies, by program, the audits that will be undertaken. For example:

• AoA - an audit of one state's Older Americans Act program
• CMS - reliability of hospital reported quality measure data
• CMS - nursing home residents age 65 and older who received anti-psychotic drugs
• ACF - TANF

FY2009Work Plan (table of contents begins on page ix)