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HHS OIG — Access to Care: Provider Availability in Medicaid Managed Care

December 12, 2014 Comments off

Access to Care: Provider Availability in Medicaid Managed Care
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, States can opt to expand Medicaid eligibility, and even States that have not expanded eligibility have seen increases in enrollment. Most States provide some of their Medicaid services-if not all of them-through managed care. OIG received a congressional request to evaluate the adequacy of access to care for enrollees in managed care. This report determines the extent to which providers offer appointments to enrollees and the timeliness of these appointments. A companion report issued earlier this year, State Standards for Access Care in Medicaid Managed Care, OEI-02-11-00320, found that State standards for access to care vary, and that they are often not specific to certain provider types or to areas of the State. Additionally, States have different strategies to assess compliance with access standards.

HOW WE DID THIS STUDY
We based this study on an assessment of availability of Medicaid managed care providers. The assessment included calls to a stratified random sample of 1,800 primary care providers and specialists to assess availability and timeliness of appointments for enrollees.

WHAT WE FOUND
We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

WHAT WE RECOMMEND
Together, these findings-along with those from our companion report-call for CMS to work with States to improve the oversight of managed care plans. We recommend that CMS work with States to (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed. CMS concurred with all three of our recommendations.

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DHS OIG — DHS Open Unresolved Recommendations Over Six Months Old, as of September 30, 2014

December 10, 2014 Comments off

DHS Open Unresolved Recommendations Over Six Months Old, as of September 30, 2014
Source: U.S. Department of Homeland Security, Office of Inspector General

The list includes all the unresolved issues raised by OIG audits and inspections reports, some dating back over six years.

The list includes the report number, title, recommendation, date issued, DHS agency, and number of days the recommendation has remained unresolved.

USPS OIG — Semiannual Report to Congress: April 1 — September 30, 2014

December 5, 2014 Comments off

Semiannual Report to Congress: April 1 — September 30, 2014 (PDF)
Source: U.S. Postal Service, Office of Inspector General

The Office of Inspector General (OIG) – together with the U.S. Postal Service Board of Governors, Congress, and Postal Service management – plays a key role in maintaining the integrity and accountability of the U.S. Postal Service, its revenue and assets, and its employees through our audit and investigative work.

OIG efforts have resulted in significant savings opportunities and improved efficiencies. The financial impact from our workers’ compensation fraud cases alone more than covers the OIG’s budget. When all of our investigative work and audit and research efforts are taken into account, we are providing strong value to stakeholders as we fulfill our mission of promoting integrity and accountability.

During the 6-month report period ending September 30, 2014, we issued 100 audit reports, management advisories, PARIS risk models and white papers, and the Postal Service accepted 87 percent of our significant recommendations. We completed 2,082 investigations that led to 335 arrests and nearly $573 million in fines, restitutions, and recoveries, $52 million of which went to the Postal Service.

DoD OIG — Guide to Investigating Military Whistleblower Reprisal and Restriction Complaints

December 2, 2014 Comments off

Guide to Investigating Military Whistleblower Reprisal and Restriction Complaints
Source: U.S. Department of Defense, Office of Inspector General

DoD IG is pleased to announce the release of a new investigating officer guide for investigating complaints of military whistleblower reprisal and restriction. This is strictly a guide, does not prescribe procedures, and does not supersede any law, directive, instruction or regulation.

DHS OIG — Major Management and Performance Challenges Facing the Department of Homeland Security

November 22, 2014 Comments off

Major Management and Performance Challenges Facing the Department of Homeland Security (PDF)
Source: U.S. Department of Homeland Security, Office of Inspector General

We have identified major challenges that affect both the Department as a whole, as well as individual components. DHS must continually seek to integrate management operations under an authoritative governing structure capable of effectively overseeing and managing programs that cross component lines.

DHS’ mission to protect the Nation from domestic and international threats and respond to natural and manmade disasters is further challenged by the unpredictable nature of these hazards. DHS must overcome the challenges inherent with uniting the Department under the Secretary’s Unity of Effort Initiative, as well as those over which it has little control.

This year, we are reporting the Department’s major challenges in the following areas:
• DHS Operations Integration
• Acquisition Management
• Financial Management
• IT Management and Privacy Issues
• Transportation Security
• Border Security and Immigration Enforcement
• Grants Management
• Employee Accountability and Integrity
• Infrastructure Protection, Cybersecurity, and Insider Threat

USPS OIG — Guiding Principles for a New Universal Service Obligation

November 19, 2014 Comments off

Guiding Principles for a New Universal Service Obligation
Source: U.S. Postal Service, Office of Inspector General

The U.S. Postal Service’s universal service obligation (USO), which establishes what mail services the Postal Service must provide, lacks a clear, comprehensive definition. The current USO is assumed to be a hodgepodge of various legal requirements and regulations that, in most cases, provide only broad guidance. For example, while public access to postal services is an important component of USO, there are no specifics about how many access points such as mail collection boxes or post offices must exist.

Add in the disruptive and transformative effects of digital communications, which have cut into mail volumes, and it’s clear that the Postal Service USO needs addressing: What exact services do policy makers and the American public – senders as well as receivers – now need the Postal Service to provide?

Our white paper, Guiding Principles for a New Universal Service Obligation,says that now is the appropriate time to update and clarify the USO. We used lessons learned from existing literature, input from experts, and its own knowledge of the Postal Service to develop six guiding principles, which are intended to help filter the plethora of information and stakeholder input to frame substantive discussion and debate on a new USO.

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HHS OIG — CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services

November 18, 2014 Comments off

CMS Needs To Do More To Improve Medicaid Children’s Utilization of Preventive Screening Services
Source: U.S. Department of Health and Human Services, Office of Inspector General

Summary

WHY WE DID THIS STUDY
In a 2010 report entitled Most Medicaid Children in Nine States Are Not Receiving All Required Preventive Screening Services, OEI-05-08-00520, OIG found that children enrolled in Medicaid were not receiving all required Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screenings. In addition, OIG also found that children who received medical screenings were not receiving complete medical screenings. The 2010 OIG report recommended improvements in both areas. CMS concurred, or partially concurred, with the recommendations. This memorandum report describes the steps that CMS has taken since the OIG’s 2010 report to encourage children’s participation in EPSDT screenings and to ensure that providers deliver complete medical screenings.

HOW WE DID THIS STUDY
We conducted structured interviews with the CMS staff responsible for EPSDT and four representatives from a national workgroup that CMS created to address EPSDT issues. We also reviewed documents provided by CMS or workgroup representatives, including informational bulletins, strategy guides, Web seminars, and workgroup reports. In addition, we reviewed States’ reports on EPSDT participation from 2006-2013, as well as the national aggregate reports for those same years.

WHAT WE FOUND
We found that CMS has taken actions toward encouraging participation in EPSDT screenings and toward encouraging the delivery of all components of medical screenings, but that it has not fully addressed OIG’s recommendations. Further, we found that children’s participation in EPSDT medical screenings remained lower than established goals. Although the national participation ratio improved from 56 percent in 2006 to 63 percent in 2013, both ratios are below the Secretary’s goal of 80 percent participation.

Given the results of our review, OIG considers all four of the recommendations from the 2010 report to remain open. This report contains no new recommendations, but we reiterate the following recommendations from 2010: CMS should (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

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