Feds and Tenet reach agreement

“Affairs Public” @LIST.NIH.GOV on 09/28/2006
11:15:44 AM

Sent by:    owner-hhs-oig-media-l@LIST.NIH.GOV


Subject:    OIG Posts Tenet CIA/Release, MFCU 04/05 Annual, 3 Audits   9/28

Hello To All,

OIG today posts a Corporate Integrity Agreement with Tenet Healthcare
Corporation and an accompanying press release.

From the press release:

OIG Executes Tenet Corporate Integrity Agreement
Unprecedented Provisions Include Board of Directors Review

Inspector General Daniel R. Levinson announced today that the Office of
Inspector General (OIG) of the U.S. Department of Health & Human
Services has reached an agreement with Tenet Healthcare Corporation on a
Corporate Integrity Agreement (CIA).  The CIA is part of Tenet’s
resolution of its civil and administrative liability for a wide range of
investigated conduct, including Diagnosis Related Group (DRG) upcoding,
improper outlier payments, kickbacks to physicians, and other fraudulent

“OIG is committed to protecting the integrity of Federal health care
programs, and today’s Corporate Integrity Agreement with Tenet
Healthcare Corporation contains comprehensive and unprecedented
provisions designed to prevent future harm to the programs.  OIG expects
Tenet to fully comply with the requirements of the Corporate Integrity
Agreement, and we will closely monitor Tenet’s compliance with its
terms,” said Inspector General Daniel R. Levinson.

For the full press release, go here:

The Tenet CIA document is here:

Also today, OIG is posting the Fiscal Year 2004/2005 Medicaid Fraud
Control Unit Annual Report.  Go here:

The enactment of the Medicare and Medicaid Anti-Fraud and Abuse
Amendments of 1977 authorized the establishment of, and Federal funding
for, the State Medicaid Fraud Control Units (SMFCUs). Currently, 47
States and the District of Columbia participate in the Medicaid fraud
control grant program through their established SMFCU. The majority of
the Units are located within the Office of State Attorneys General. A
small number of the Units are located in various other State Agencies.
The mission of the Medicaid fraud units is to investigate and prosecute
Medicaid provider fraud and incidences of patient abuse and neglect.

The Inspector General is delegated the authority to annually certify
each SMFCU as eligible to receive Federal grant funds under the Medicaid
fraud control program. The Medicaid fraud units receive 90 percent
Federal funding for the first 3 years of operation and 75 percent
thereafter. A primary goal of the OIG is to ensure that each unit fully
complies with all Federal regulations governing the functions and
operations of a Medicaid fraud unit.

Finally, OIG is today also posting three new Audit reports.  As always,
selecting the link immediately following the report title will take you
directly to the full document.

Nationwide Review of Inpatient Rehabilitation Facilities’ Compliance
With Medicare’s Transfer Regulation (A-04-04-00008)

Our objective was to determine whether inpatient rehabilitation
facilities (IRFs) coded claims as “discharged to home” in compliance
with Medicare’s transfer regulation during fiscal year (FY) 2003.  IRFs
did not always code claims in compliance with Medicare’s transfer
regulation.  Nationwide we identified 2,473 IRF claims coded and paid as
discharges to home that potentially should have been paid as transfers.
We visited or contacted seven IRFs that were responsible for 112 of
these claims and found that all 112 claims should have been coded as
transfers rather than as discharges.

We recommended that CMS:  (1) instruct the fiscal intermediaries to
review the claims in question and to recover, as appropriate, the
estimated $11,967,555 in potential overpayments, (2) instruct the fiscal
intermediaries to review claims paid after our audit period for possible
coding errors like those found in this review, and (3) implement edits
in the Common Working File that match beneficiary discharge dates with
admission dates to other providers to identify potentially miscoded
claims.  CMS concurred with the recommendations and requested that we
furnish the necessary data to initiate recovery of the overpayments.  We
have provided CMS with the requested data.

Review of Durable Medical Equipment Providers’ Medicaid Claims for NY
Residents of Assisted Living Programs (A-02-05-01017)

Our objective was to determine whether durable medical equipment (DME)
providers improperly received Medicaid reimbursement for medical
supplies and equipment not requiring prior approval that were already
included in the per diem rates paid to assisted living programs (ALPs).
New York prohibits Medicaid payments to DME providers for items
furnished by a facility or organization when the cost of those items is
already included in the per diem rate.  The DME providers improperly
received Medicaid reimbursement for medical supplies and equipment not
requiring prior approval that were furnished to ALP residents.  As a
result, $406,081 in Federal funds was improperly claimed under the
Medicaid program.  Our report recommended that the State:  (1) refund
$406,081 to the Federal Government, (2) establish eMedNY edits and
controls necessary to deny DME provider claims for Medicaid
reimbursement for medical supplies and equipment not requiring prior
approval that were furnished to ALP residents, and (3) issue guidance to
DME providers emphasizing that State regulations prohibit Medicaid
payment for items included in the ALPs’ per diem rates.  The State
generally concurred with all three recommendations

Audit of Whitman-Walker Clinic’s Adequacy of Patient Care

Our objective was to determine if an allegation submitted to the Office
of Inspector General that the Whitman-Walker Clinic conducted medically
unnecessary and time-consuming testing procedures that contributed to
the medical deterioration and eventual death of an AIDS patient could be
substantiated.  There was no evidence to substantiate the allegation.
The tests performed for the patient were both necessary as a basis for
treatment and conducted within acceptable timeframes.  Accordingly,
there were no recommendations as a result of this audit.

Well, 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 (paffairs@oig.hhs.gov) or by phone (202/619-1343) how we can help.
Here’s hoping your week is has been proceeding nicely!  — Don White,
Public Affairs   http://oig.hhs.gov

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