Fwd: OIG posts 2 reports, 2 SFCA review updates, a video and news about enforcement actions - 8/5

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From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Tue, Aug 5, 2014 at 7:11 AM
Subject: OIG posts 2 reports, 2 SFCA review updates, a video and news about enforcement actions - 8/5
To: iammejtm@gmail.com

Good morning from Washington, DC. Today OIG posts 2 reports, 2 updated State False Claims Act Reviews, a video and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------   Weaknesses in Molina's Information System General Controls over Its Medicaid Claims Processing System Increase Vulnerabilities (A-09-13-03001) http://go.usa.gov/NnKB   The Idaho Department of Health and Welfare (State agency) did not ensure that Molina Medicaid Solutions (Molina) implemented adequate information system general controls over the State agency's Medicaid Management Information System (MMIS). We identified 21 reportable weaknesses, which we consolidated into 6 findings.   Specifically, Molina had weak user authentication for remote network access, an inadequate password history policy, and inadequate encryption of network passwords; inadequate security settings for network devices, inadequate management of the Medicaid claims database, and no written policies for patch management; and no security policies and procedures to periodically review and account for inventory of portable devices, no policies and procedures for annual security awareness training, and inadequate policies and procedures for terminated and transferred employees and for background checks of employees.   We recommended that the State agency ensure that Molina implements adequate information system general controls over the State agency's MMIS. The State agency concurred with all of our specific recommendations except for parts of two recommendations.     ------------------------------------------------------------------------------   The Centers for Medicare & Medicaid Services Paid Medicare Advantage Organizations for Services Provided to Beneficiaries Confined in Mental Health Facilities for Court-Ordered Purposes (A-07-13-06041) http://go.usa.gov/NnBJ   During calendar years 2006 through 2011, the Centers for Medicare & Medicaid Services (CMS) CMS accepted prescription drug event records from Medicare Part D sponsors totaling over $12.6 million on behalf of beneficiaries who were confined in mental health facilities by court order under a penal code (confined beneficiaries). Had those same persons been enrolled in Medicare Parts A or B, payment for Parts A or B services would generally not have been made. This occurred because CMS policy permits Medicare payments to be made on behalf of confined beneficiaries enrolled in Part D but not on behalf of those enrolled in Part A or Part B.     Federal regulations state that an individual is eligible for Medicare Part D benefits if he or she is entitled to benefits under Part A or enrolled in Part B and lives in the service area of a Part D plan. However, under current policy for the administration of Part D, CMS does not consider confined beneficiaries to be incarcerated for the purpose of Part D eligibility, regardless of the reason for their confinement. For Medicare Parts A and B, beneficiaries in custody of penal authorities include confined beneficiaries. Medicare generally does not pay Part A and Part B benefits to incarcerated beneficiaries, but those beneficiaries retain their entitlement to Part A and can retain their enrollment in Part B with the payment of premiums. Accordingly, these individuals would be eligible for payments under Part D   We recommend that, to be consistent with the relevant provisions of Medicare Part A and Part B, CMS revise the Manual to prohibit Part D payments made on behalf of confined beneficiaries, which could have resulted in cost savings associated with $12.6 million in gross drug costs that CMS accepted for the 6-year period we reviewed. CMS concurred with our recommendation and described corrective actions that it had taken or planned to take.   ------------------------------------------------------------------------------   State False Claims Act Updates   Virginia Review http://go.usa.gov/NnZC   Indiana Review http://go.usa.gov/NnZW   ------------------------------------------------------------------------------   Video: HHS-OIG testifies on Eligibility Concerns with ACA Enrollment on July 16, 2014 http://go.usa.gov/NnBT   In case you missed it, now you can watch Kay Daly, Assistant Inspector General, Office of Audit Services and Joyce Greenleaf, Regional Inspector General for the Office of Evaluation and Inspections, Office of Inspector General, U.S. Department of Health and Human Services testify before the House Committee on Energy and Commerce, Subcommittee on Health: Failure To Verify: Concerns Regarding ACA's Eligibility System on July 16, 2014.   ------------------------------------------------------------------------------   August 4, 2014; U.S. Department of Justice Community Health Systems Inc. to Pay $98.15 Million to Resolve False Claims Act Allegations http://go.usa.gov/NXZP   ------------------------------------------------------------------------------   July 31, 2014; Office of Inspector General; U.S. Department of health and Human Services Missouri Health Care IT and Pharmacy Benefits Manager Settles Case Involving Allegations of Fraudulent Medicare Part D Claims http://go.usa.gov/NnWP   ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/NXWh   ------------------------------------------------------------------------------   That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov   Make it a great day!   Marc Wolfson – Office of External Affairs   OIG's privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Visit subscriberhelp.govdelivery.com This email was sent to iammejtm@gmail.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775

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Jeremy Tobias Matthews