From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Tue, Aug 26, 2014 at 6:35 AM
Subject: OIG posts 3 reports, a State FCA review letter and news about enforcement actions - 8/26
To: iammejtm@gmail.com
Good morning from Washington, DC. Today OIG posts 3 reports, an updated State False Claims Act review letter for Connecticut and news about enforcement actions. As always, you can use the links provided to go directly to the new material.
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An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace (OEI 03 14 00231) http://go.usa.gov/mEnj
WHY WE DID THIS STUDY The Patient Protection and Affordable Care Act required the establishment of a health insurance exchange (marketplace) in each State. For States that elect not to establish their own marketplaces, the Federal Government is required to operate a marketplace on behalf of the State. A marketplace is designed to serve as a one-stop shop where individuals can obtain information about their health insurance options, determine eligibility for insurance affordability programs, and select the plan of their choice. CMS operates the Federally Facilitated Marketplace (Federal Marketplace). CMS relied—and continues to rely extensively—on contractors to operate the Federal Marketplace. This report is the first in a series that will address the planning, acquisition, management, and performance oversight of Federal Marketplace contracts, as well as various aspects of Federal Marketplace operations. This report provides descriptive and financial data on 60 contracts related to the development of the Federal Marketplace at HealthCare.gov.
HOW WE DID THIS STUDY CMS identified 60 contracts ("the contracts") related to the development and operation of the Federal Marketplace. Not all of these contracts were awarded solely for the purpose of the Federal Marketplace. To determine the estimated value of the contracts and the amount obligated for the contracts as of February 2014, OIG analyzed contract, order, and modification documentation provided by CMS for the 60 contracts. We calculated the total obligation and expenditure amounts related to the Federal Marketplace portions of each contract by summarizing the financial accounting transactions that CMS identified as related to the Federal Marketplace for each contract. These financial accounting transactions (obligations and expenditures) include all transactions that CMS processed through its Healthcare Integrated General Ledger Accounting System (HIGLAS) as of February 28, 2014, that CMS had provided to us as of June 18, 2014.
SUMMARY The 60 contracts related to the development and operation of the Federal Marketplace started between January 2009 and January 2014. The purpose of the 60 contracts ranged from health benefit data collection and consumer research to cloud computing and Web site development. The original estimated values of these contracts totaled $1.7 billion; the contract values ranged from $69,195 to over $200 million. Across the 60 contracts, nearly $800 million has been obligated for the development of the Federal Marketplace as of February 2014. As of that date, CMS had paid nearly $500 million for the development of the Federal Marketplace to the contractors awarded these contracts.
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Some Louisiana Child Day Care Centers Did Not Always Comply With State Health and Safety Licensing Requirements (A-06-13-00036) http://go.usa.gov/mERQ
Although the Department of Children and Family Services (State agency) conducted the required onsite monitoring at all four of the providers that we reviewed, it did not ensure that providers that received Child Care and Development Fund (CCDF) funds complied with State licensing requirements related to the health and safety of children. All four providers that we reviewed did not comply with one or more State licensing requirements to ensure the health and safety of children. Specifically, we found that the four providers did not always comply with State licensing requirements related to physical conditions, and one of the providers did not comply with all of the required criminal records and child abuse and neglect registry check requirements. In addition, one provider exceeded the allowable child-to-staff ratio.
We recommended that the State agency require providers to complete specific training requirements related to health and safety regulations and ensure that all providers' employees who provide direct services to children have had criminal records and child abuse and neglect registry checks. The State agency agreed with our findings and said that it had conducted follow-up visits to providers and that the providers had corrected all deficiencies identified in our report. In addition, the State agency said that it is not in a position to implement our recommendations because the State is currently transitioning authority over CCDF to another State department. However, the State agency said that it would share the recommendations with the succeeding department.
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Some Louisiana Family Child Day Care Home Providers Did Not Always Comply With State Health and Safety Requirements (A-06-13-00037) http://go.usa.gov/mERe
Providers in Louisiana who received Child Care and Development Fund (CCDF) funds did not always comply with applicable State requirements on ensuring the health and safety of children in their care. Specifically, each of the 20 providers who we reviewed did not comply with at least 1 of the applicable registration requirements, and 7 providers did not comply with required criminal background checks. The State issued disqualification notices to eight providers after we notified them of our results. The Department of Children and Family Services' (State agency) oversight was not adequate to ensure that providers complied with State health and safety regulations.
We recommended that the State agency perform periodic onsite visits to providers to ensure compliance with registration and program requirements, including compliance with criminal background checks. The State agency described actions that it has taken to address our findings. The State agency also said that contractors monitor providers on site. However, the State agency did not provide any documentation to support that the monitoring covered health and safety requirements. In addition, the State agency said that it cannot implement our recommendation because the State is currently transitioning authority over CCDF to another State department. However, the State agency said that it would share the recommendation with the succeeding department.
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Updated State False Claims Act Review for Connecticut http://go.usa.gov/mEn5 The OIG, in consultation with the Attorney General, determines whether States have false claims acts that qualify for an incentive under section 1909 of the Social Security Act. Those States deemed to have qualifying laws receive a 10-percentage-point increase in their share of any amounts recovered under such laws.
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August 25, 2014; U.S. Department of Justice Louisiana Psychiatrist Sentenced to Serve More Than Seven Years in Prison for His Role in $258 Million Medicare Fraud Scheme http://go.usa.gov/NXZP
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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
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Jeremy Tobias Matthews
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