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HHS OIG — Medicare Part B Prescription Drug Dispensing and Supplying Fee Payment Rates Are Considerably Higher Than the Rates Paid by Other Government Programs

September 19, 2014 Comments off

Medicare Part B Prescription Drug Dispensing and Supplying Fee Payment Rates Are Considerably Higher Than the Rates Paid by Other Government Programs
Source: U.S. Department of Health and Human Services, Office of Inspector General

Medicare Part B would have saved millions of dollars in 2011 if dispensing fees for inhalation drugs administered through durable medical equipment and supplying fees for immunosuppressive drugs associated with an organ transplant, oral anticancer chemotherapeutic drugs, and oral antiemetic drugs used as part of an anticancer chemotherapeutic regimen had been aligned with the rates that Part D and State Medicaid programs paid. Part B paid $132.9 million in dispensing and supplying fees. We estimated that if Part B rates had been the same as the average Part D rates, Part B would have paid dispensing and supplying fees of $22 million, a savings of $110.9 million. We also estimated that if Part B rates had been the same as the average State Medicaid program rates, Part B would have paid dispensing and supplying fees of $26.6 million, a savings of $106.3 million.

We recommended that CMS amend current regulations to decrease the Part B payment rates for dispensing and supplying fees to rates similar to those of other payers, such as Part D and Medicaid. CMS did not concur with our recommendation and requested that OIG conduct a study to identify the specific activities involved with dispensing inhalation drugs and supplying oral drugs under Part B and collect information about the actual costs that are directly associated with dispensing these Part B drugs. We maintain that pharmacies are overpaid for dispensing drugs under Part B when compared with what they are paid for dispensing the same drugs under Part D and Medicaid.

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New From the GAO

September 19, 2014 Comments off

New GAO Reports and Testimony
Source: Government Accountability Office

Reports

1. Federal Real Property: DHS and GSA Need to Strengthen the Management of DHS Headquarters Consolidation. GAO-14-648, September 19.
http://www.gao.gov/products/GAO-14-648
Highlights – http://www.gao.gov/assets/670/665943.pdf

2. DOD Joint Bases: Implementation Challenges Demonstrate Need to Reevaluate the Program. GAO-14-577, September 19.
http://www.gao.gov/products/GAO-14-577
Highlights – http://www.gao.gov/assets/670/665963.pdf

3. Fish Stock Assessments: Prioritization and Funding. GAO-14-794R, September 19.
http://www.gao.gov/products/GAO-14-794R

Testimony

1. Federal Real Property: DHS and GSA Need to Strengthen the Management of DHS Headquarters Consolidation, by David C. Maurer, director, homeland security and justice, before the Subcommittee on Oversight and Management Efficiency, House Committee on Homeland Security. GAO-14-864T, September 19.
http://www.gao.gov/products/GAO-14-864T

CRS — Delayed Federal Grant Closeout: Issues and Impact (September 12, 2014)

September 18, 2014 Comments off

Delayed Federal Grant Closeout: Issues and Impact (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Federal outlays for grants to state and local governments have grown from $15.4 billion in 1940 (in constant FY2009 dollars) to $509.7 billion in 2013 (in constant FY2009 dollars). The number of congressionally authorized grant programs has also increased over time, with over 2,179 congressionally authorized grant programs currently being administered by federal agencies. Recently, congressional interest has focused on the efficient and effective management of federal grant programs. A recent congressional hearing evaluated the impact of alleged inefficient grant management which, according to a GAO report, resulted in more than $794 million in undisbursed federal grant funds in expired grant accounts. GAO concluded that federal agencies needed to improve the timeliness of federal grant closeouts to address the undisbursed funds issue. However, there may be underlying causes, other than inefficient grant management, that might help to explain why undisbursed funds may end up in expired grant accounts. Furthermore, it is possible, if not likely, that the estimated amount of undisbursed funds in expired grant accounts may be inflated. While the undisbursed grant funds identified by GAO represent significantly less than 1% of annual outlays for grants to state and local governments, the existence of undisbursed grant funds in expired grant accounts is an indicator of a systemic grants management challenge; suggesting a lack of coordination between the financial and program management of federal grants.

New From the GAO

September 18, 2014 Comments off

New From the GAO
Source: Government Accountability Office

Reports

1. Inspectors General: Improvements Needed in the Office of Inspector General’s Oversight of the Denali Commission. GAO-14-320, September 18.
http://www.gao.gov/products/GAO-14-320
Highlights – http://www.gao.gov/assets/670/665909.pdf

2. Secure Flight: TSA Should Take Additional Steps to Determine Program Effectiveness. GAO-14-531, September 9.
http://www.gao.gov/products/GAO-14-531
Highlights – http://www.gao.gov/assets/670/665677.pdf

3. Secure Flight: TSA Could Take Additional Steps to Strengthen Privacy Oversight Mechanisms. GAO-14-647, September 9.
http://www.gao.gov/products/GAO-14-647
Highlights – http://www.gao.gov/assets/670/665674.pdf

4. VA Health Care: Actions Needed to Address Higher-Than-Expected Demand for the Family Caregiver Program. GAO-14-675, September 18.
http://www.gao.gov/products/GAO-14-675
Highlights – http://www.gao.gov/assets/670/665929.pdf

5. Large Partnerships: With Growing Number of Partnerships, IRS Needs to Improve Audit Efficiency. GAO-14-732, September 18.
http://www.gao.gov/products/GAO-14-732
Highlights – http://www.gao.gov/assets/670/665887.pdf

6. Depot Maintenance: Accurate and Complete Data Needed to Meet DOD’s Core Capability Reporting Requirements. GAO-14-777, September 18.
http://www.gao.gov/products/GAO-14-777
Highlights – http://www.gao.gov/assets/670/665916.pdf

Testimonies

1. Healthcare.gov: Information Security and Privacy Controls Should Be Enhanced to Address Weaknesses, by Gregory C. Wilshusen, director, information security issues, before the House Committee on Oversight and Government Reform. GAO-14-871T, September 18.
http://www.gao.gov/products/GAO-14-871T
Highlights – http://www.gao.gov/assets/670/665878.pdf

2. Secure Flight: Additional Actions Needed to Determine Program Effectiveness and Strengthen Privacy Oversight Mechanisms, by Jennifer Grover, acting director, homeland security and justice, before the Subcommittee on Transportation Security, House Committee on Homeland Security. GAO-14-796T, September 18.
http://www.gao.gov/products/GAO-14-796T

Press Release

1. GAO Names New Members to PCORI Methodology Committee. September 18.
http://www.gao.gov/press/pcori_methodology_comm2014sep18.htm

Reissue

1. Critical Infrastructure Protection: DHS Action Needed to Enhance Integration and Coordination of Vulnerability Assessment Efforts. GAO-14-507, September 15.
http://www.gao.gov/products/GAO-14-507
Highlights – http://www.gao.gov/assets/670/665787.pdf

HHS OIG — Hospital Emergency Preparedness and Response During Superstorm Sandy

September 18, 2014 Comments off

Hospital Emergency Preparedness and Response During Superstorm Sandy
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Federal regulations require that hospitals prepare for emergencies including natural disasters. The strength of Superstorm Sandy and the population density of the affected areas placed high demands on hospitals and related services. Prior studies by OIG found substantial challenges in health care facility emergency preparedness and response. In a 2006 study, we found that many nursing homes had insufficient emergency plans or did not follow their plans. In a 2012 followup study, we found that gaps continued to exist in nursing home emergency preparedness and response.

HOW WE DID THIS STUDY
For this study, we surveyed 174 Medicare-certified hospitals located in declared disaster areas in Connecticut, New Jersey, and New York during Superstorm Sandy. We also conducted site visits to 10 purposively selected hospitals located in areas most affected by the storm. Additionally, we examined information from State survey agency and accreditation organization surveys of hospitals conducted prior to the storm and spoke to surveyors about their survey process related to emergency preparedness. We also interviewed State hospital associations and health care coalitions in the three States.

WHAT WE FOUND
Most hospitals in declared disaster areas sheltered in place during Superstorm Sandy, and 7 percent evacuated. Eighty-nine percent of hospitals in these areas reported experiencing substantial challenges in responding to the storm. These challenges represented a range of interrelated problems from infrastructure breakdowns, such as electrical and communication failures, to community collaboration issues over resources, such as fuel, transportation, hospital beds, and public shelters. Hospitals reported that prior emergency planning was valuable during the storm and that they subsequently revised their plans as a result of lessons learned. Prior to the storm, most hospitals received emergency-related deficiency citations from hospital surveyors, some of which related to the challenges reported by hospitals during Superstorm Sandy.

WHAT WE RECOMMEND
The experiences of hospitals during Superstorm Sandy and the deficiencies cited prior to the storm reveal gaps in emergency planning and execution that might be applicable to hospitals nationwide. Given that insufficient community-wide coordination among affected entities was a common thread through the challenges identified by hospital administrators, we recommend that ASPR continue to promote Federal, State, and community collaboration in major disasters. We also recommend that CMS examine existing policies and provide guidance regarding flexibility for reimbursement under disaster conditions. ASPR and CMS concurred with the recommendations.

Fiscal year 2014 statutory audit of compliance with notifying taxpayers Of their rights when requested to extend the assessment statute

September 18, 2014 Comments off

Fiscal year 2014 statutory audit of compliance with notifying taxpayers Of their rights when requested to extend the assessment statute
Source: Treasury Inspector General for Tax Administration

IMPACT ON TAXPAYERS
The IRS is required by law to notify taxpayers of their rights when requesting an extension of the statute of limitations for assessing additional taxes and penalties. Taxpayers might be adversely affected if the IRS does not follow the requirements to notify both the taxpayers and their representatives of the taxpayers’ rights related to assessment statute extensions.

WHY TIGTA DID THE AUDIT
TIGTA is required by law to annually determine whether the IRS complied with Internal Revenue Code Section 6501(c)(4)(B), which requires that the IRS provide notice to taxpayers of their rights to decline to extend the assessment statute of limitations or to request that any extension be limited to a specific period of time or specific issues.

WHAT TIGTA FOUND
TIGTA’s review of a statistical sample of 59 closed taxpayer audit files with assessment statute extensions found that the IRS is generally compliant with Internal Revenue Code Section 6501(c)(4)(B). However, TIGTA identified a few instances in which the taxpayer audit files did not contain documentation to support that the taxpayer or the taxpayer’s representative were properly notified of the taxpayer’s rights.

WHAT TIGTA RECOMMENDED
TIGTA did not make any recommendations in this report because the number of errors was relatively small and the recommendations made in previous TIGTA audit reports are still valid for the issues reported. IRS officials were provided an opportunity to review the draft report and did not provide any comments.

Annual Review of the United States Coast Guard’s Mission Performance (FY 2013)

September 18, 2014 Comments off

Annual Review of the United States Coast Guard’s Mission Performance (FY 2013) (PDF)
Source: U.S. Department of Homeland Security, Office of Inspector General

This report presents our annual review of the United States Coast Guard’s (USCG) mission performance, as required by the Homeland Security Act of 2002. The act defines the USCG’s 11 statutory missions as either non-homeland security missions or homeland security. The act also prohibits the Secretary of Homeland Security from substantially reducing any of the USCG’s missions after its transfer to the Department of Homeland Security, except as specified in subsequent acts.

The objective of this review was to determine the extent to which the USCG is maintaining its historical level of effort on non-homeland security missions. To address our objective, we reviewed the resource hours the USCG used to perform its various missions. We also reviewed the USCG’s performance measures and results for each non-homeland security and homeland security mission. We did not verify the accuracy of the USCG-provided data.

According to USCG’s data, the majority of resource hours are no longer dedicated to homeland security missions. For fiscal year 2013, the USCG dedicated about the same percentage of resource hours to homeland security missions as to non-homeland security missions.

The USCG reported that it met or exceeded 15 of 23 summary performance measure targets in fiscal year 2013. This includes 9 of 12 non-homeland security performance measures and 6 of 11 homeland security performance measures targets. In fiscal year 2013, the USCG budgeted nearly the same percentage of funding to its nonͲhomeland security and homeland security missions.

This report contains no recommendations.

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