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HHS OIG — Medicare Paid for HIV Drugs for Deceased Beneficiaries

October 31, 2014 Comments off

Medicare Paid for HIV Drugs for Deceased Beneficiaries
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Under the Medicare Part D program, CMS contracts with private insurance companies, known as sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. OIG has had ongoing concerns about Medicare paying for drugs and services after a beneficiary has died.
Drugs that treat the human immunodeficiency virus (HIV) can be a target for fraud, waste, and abuse, primarily because they can be very expensive. Although this report focuses on HIV drugs, the issues raised are relevant to all Part D drugs.

HOW WE DID THIS STUDY
We based this study on an analysis of Prescription Drug Event (PDE) records for HIV drugs in 2012. Part D sponsors submit these records to CMS for each drug dispensed to beneficiaries enrolled in their plans. Each record contains information about the drug, beneficiary, pharmacy, and prescriber. We used the Beneficiary Enrollment Database, the Social Security Administration’s Death Master File, and Accurint’s Death Records to identify beneficiaries’ dates of death.

WHAT WE FOUND
Medicare paid for HIV drugs for over 150 deceased beneficiaries. CMS’s current practices allowed most of these payments to occur. Specifically, CMS has edits (i.e., systems processes) in place that reject PDE records for drugs with dates of service more than 32 days after death. CMS’s practices allow payment for drugs that do not meet Medicare Part D coverage requirements. Most of these drugs were dispensed by retail pharmacies.
This review looked only at HIV drugs, which account for one-quarter of one percent of all Part D drugs in 2012. However, our findings have implications for all drugs because Medicare processes PDE records for all drugs the same way. Considering the enormous number of Part D drugs, a change in practice would affect all Part D drugs and could result in significant cost savings for the program and for taxpayers.

WHAT WE RECOMMEND
We recommend that CMS change its practice of paying for drugs that have a date of service within 32 days after the beneficiary’s death. CMS should eliminate or-if necessary for administrative processing issues-shorten the window in which it accepts PDE records for drugs dispensed after a beneficiary’s death. Such a change would prevent inappropriate payments for drugs for deceased beneficiaries and lead to cost savings for the program and for taxpayers. CMS concurred with our recommendation.

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New From the GAO

October 30, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Pension Plan Valuation: Views on Using Multiple Measures to Offer a More Complete Financial Picture. GAO-14-264, September 30.
http://www.gao.gov/products/GAO-14-264
Highlights – http://www.gao.gov/assets/670/666288.pdf

2. DOD Business Systems Modernization: Additional Enhancements Are Needed for Army Business System Schedule and Cost Estimates to Fully Meet Best Practices. GAO-14-470, September 30.
http://www.gao.gov/products/GAO-14-470
Highlights – http://www.gao.gov/assets/670/666294.pdf

3. Federal Real Property: More Useful Information to Providers Could Improve the Homeless Assistance Program. GAO-14-739, September 30.
http://www.gao.gov/products/GAO-14-739
Highlights – http://www.gao.gov/assets/670/666258.pdf

4. VA Health Care: Management and Oversight of Consult Process Need Improvement to Help Ensure Veterans Receive Timely Outpatient Specialty Care. GAO-14-808, September 30.
http://www.gao.gov/products/GAO-14-808
Highlights – http://www.gao.gov/assets/670/666249.pdf
Podcast – http://www.gao.gov/multimedia/podcasts/666528

5. Energy Policy: Information on Federal and Other Factors Influencing U.S. Energy Production and Consumption from 2000 through 2013. GAO-14-836, September 30.
http://www.gao.gov/products/GAO-14-836
Highlights – http://www.gao.gov/assets/670/666271.pdf

6. Disability Compensation: Review of Concurrent Receipt of Department of Defense Retirement, Department of Veterans Affairs Disability Compensation, and Social Security Disability Insurance. GAO-14-854R, September 30.
http://www.gao.gov/products/GAO-14-854R

7. DOD Space Systems: Additional Knowledge Would Better Support Decisions about Disaggregating Large Satellites. GAO-15-7, October 30.
http://www.gao.gov/products/GAO-15-7
Highlights – http://www.gao.gov/assets/670/666715.pdf

New From the GAO

October 29, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Chemical Assessments: Agencies Coordinate Activities, but Additional Action Could Enhance Efforts. GAO-14-763, September 29.
http://www.gao.gov/products/GAO-14-763
Highlights –  http://www.gao.gov/assets/670/666205.pdf

2. USDA Contracting: Further Actions Needed to Strengthen Oversight of Contractors for Professional Services. GAO-14-819, September 29.
http://www.gao.gov/products/GAO-14-819
Highlights – http://www.gao.gov/assets/670/666217.pdf

U.S. Executives Remain Bullish on American Manufacturing, Study Finds

October 27, 2014 Comments off

U.S. Executives Remain Bullish on American Manufacturing, Study Finds
Source: Boston Consulting Group

U.S.-based executives at large companies remain bullish on American manufacturing, and their actions are starting to show it, according to new research by The Boston Consulting Group (BCG).

The firm’s third annual survey of senior manufacturing executives at companies with sales of $1 billion or more found that the number of respondents who said that their companies are already bringing production back from China to the United States had risen 20 percent—from roughly 13 percent to 16 percent—in the past year. The number who said that they would consider returning production in the near future climbed 24 percent—from about 17 percent to 20 percent. And a majority (54 percent) expressed interest in reshoring, validating last year’s result (also 54 percent).

New From the GAO

October 27, 2014 Comments off

New GAO Report
Source: Government Accountability Office

U.S. Postal Service: Information on Recent Changes to Delivery Standards, Operations, and Performance. GAO-14-828R, September 25.
http://www.gao.gov/products/GAO-14-828R

TIGTA — Additional Measures Needed to Provide Greater Assurance That Tax Information Provided to Health Exchanges Is Protected

October 27, 2014 Comments off

Additional Measures Needed to Provide Greater Assurance That Tax Information Provided to Health Exchanges Is Protected
Source: Treasury Inspector General for Tax Administration

The Internal Revenue Service (IRS) is authorized to disclose limited tax information to Affordable Care Act Exchanges when an applicant seeks financial assistance in obtaining health insurance. To protect the confidentiality of Federal Tax Information (FTI), the IRS has established safeguards the Exchanges must employ.

While the IRS has provided staff to facilitate the readiness of ACA Exchanges to receive FTI, additional procedures are needed to provide greater assurance that FTI will be protected prior to the IRS approving its release. That is the conclusion of a report publicly released today by the Treasury Inspector General for Tax Administration (TIGTA).

DHS OIG — FEMA’s Logistics Supply Chain Management System May Not Be Effective During a Catastrophic Disaster

October 27, 2014 Comments off

FEMA’s Logistics Supply Chain Management System May Not Be Effective During a Catastrophic Disaster (PDF)
Source: U.S. Department of Homeland Security, Office of Inspector General

We audited the Federal Emergency Management Agency’s (FEMA) Logistics Supply Chain Management System program. According to FEMA, the Logistics Supply Chain Management System replaced its earlier logistics operations systems to automate and track distribution better and deliver emergency supplies more dependably. FEMA also intended for the system to help track supplies provided by partners in other Federal agencies; nongovernmental organizations; state, local, and tribal governments; and the private sector. Our audit objective was to determine whether FEMA’s Logistics Supply Chain Management System is able to support Federal logistics operations effectively in the event of a catastrophic disaster.

After spending about $247 million over 9 years, FEMA cannot be certain that its supply chain management system will be effective during a catastrophic disaster. FEMA estimated that the life cycle cost of the system would be about $556 million—$231 million more than the original life cycle cost estimate. According to FEMA, the Logistics Supply Chain Management System became fully operational in January 2013, which was about 19 months behind schedule. However, the system could not perform as originally planned. Specifically, it cannot interface with the logistics management systems of FEMA’s partners, nor does FEMA have realͲtime visibility over all supplies shipped by its partners. As of March 2014, the Logistics Supply Chain Management System still had not achieved full operational capability. We attribute these deficiencies to inadequate program management and oversight by the Department of Homeland Security (DHS) and FEMA. As a result, FEMA may not be able to efficiently and effectively aid survivors of catastrophic disaster.

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