#oig

[mysillyarthoard]

hoim mothsssss

#my art #traditional art #moths #bugs #oig

[hislop3]

OIG: CMS Should Take Action Against States with Poor SNF Survey Performance

Last week, the U.S. Department of Health and Human Services Office of the Inspector General (OIG), issued a report regarding the performance of contracted state agencies with respect to nursing home (SNF) compliance surveys. CMS contracts with state agencies, typically state departments of health or divisions thereto, to perform compliance/regulatory activities (surveys) in nursing homes. The…

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#CMS #Compliance #DHHS #enforcement #Industry Outlook #Medicaid #Medicare #Nursing Homes #OIG #penalties #Policy #Quality #Regulation #remedies #Report #SNF #SOM #State Operations Manual #States #Survey and Certification #Washington

[nine-thousand-rats]

love it when people wont leave you alone (physically like if there was an open seat next to me you'd take it wont leave me alone) and then paint me as some entitled ass

like mf just leave me alone im trying to not get mad at you

i know that you dont want me to get mad at you you complain about it so much and act like im goddamn lucifer

so like if you are so petrified of me stop sitting near me

also if there are no open seats that aren't right next me it might be because you come into class 5 minutes late every day

oig

#oig #ignore this

[syrtissolutions]

THIRD-PARTY LIABILITY DIFFICULTIES IN MEDICAID

Third-party liability, also referred to as TPL, is the legal requirement of third parties to pay part or all of the expenditures for medical assistance under a Medicaid state plan. Simply put, if a beneficiary has other forms of health insurance, those primary payers are mandated to pay their legal liability first, and Medicaid pays for any remaining liability as the payer of last resort. This policy has been in place since the Employee Retirement Income Security Act changed the Social Security Act in 1974. Nevertheless, state Medicaid agencies face ongoing challenges in meeting TPL requirements, and it is costing the program billions of dollars every year.

This October, the OIG released an updated report that highlighted the particular problems states are facing in meeting third-party liability requirements and in making sure that Medicaid functions as the payer of last resort. The OIG performed its audit by sending questionnaires to State agency officials to determine how each state collects OHI, detects TPL, processes claims with TPL, and reports TPL cost avoidance and recoveries. While there has been progress, the OIG's auditing initiatives suggest that billions of dollars are still at risk. Here is a high-level overview of the report's findings and recommendations.

DIFFICULTIES THAT STATES FACE TO MEET TPL REQUIREMENTS

According to States, the primary challenges in their attempts to meet TPL requirements are related to:

difficulties acquiring complete, accurate, and up-to-date coverage information from Medicaid enrollees and providers;

difficulties obtaining timely and reliable coverage information from third parties;

difficulties coordinating TPL with out-of-State third parties;

technical issues linked to third-party coverage information received and electronic billing of Medicaid claims with third parties;

a lack of Federal prompt payment requirements and penalties for third parties that do not cooperate with States' attempts to satisfy TPL requirements;

difficulties with third parties that reject Medicaid claims for procedural reasons;

difficulties coordinating TPL with TRICARE and;

difficulties coordinating TPL with Medicare.

OIG RECOMMENDATIONS TO ADDRESS THIRD-PARTY LIABILITY CHALLENGES

The OIG made the following recommendations to CMS to help address TPL difficulties:

use the information we obtained from States about the problems they are still facing and develop an action plan for helping States more easily identify liable third parties and recover Medicaid payments;

work with States, as appropriate, to encourage better cooperation from third parties that repeatedly resist States' TPL identification and recovery efforts;

for the four States we identified as not having fully complied with the DRA's TPL provisions: (1) verify whether the States have since come into compliance and (2) pursue corrective actions for States that have not fully complied;

verify whether Virginia has returned the $1.25 million Federal share of the Medicaid TPL collections underreported during two fiscal quarters and, if not, require Virginia to refund any remaining amount owed;

provide guidance to States to assist them with developing processes that improve the reporting of Medicaid TPL amounts on the form 64.9 A;

ensure that States have current guidance on completing the form 64.9 A;

ensure that States correctly report TPL amounts on the form 64.9 A; and

remove or disable lines from the form 64.9 A that States are supposed to leave blank.

MEDICAID PAYERS NEED INNOVATIVE TPL DATA SOLUTIONS

States' TPL challenges stem mostly from bad-quality data. Medicaid payers are unable to determine primary coverage on pharmacy and medical claims because the majority of data that they have access to is not current, available, complete, or accurate. Consequently, plans have no choice but to pay claims in error and then chase reimbursement once other primary coverage is found. To make matters even worse, the actual monies recovered from these improper payments remain around twenty cents on the dollar.

Without good quality data, Medicaid will not have the ability to overcome its TPL challenges, and the program will continue to lose billions in improper payments. Syrtis Solutions realized this, and in 2010, they introduced ProTPL. Their solution was a real-time point-of-sale cost avoidance service for payers of last resort that provides powerful and accurate eligibility data that plans can act on. ProTPL gives payers of last resort the ability to cost avoid pharmacy and medical claims in addition to the associated costs of recovery. Syrtis Solutions identifies active health coverage that no other vendors can find by checking claims against the nation's largest and most comprehensive active healthcare coverage information database. Customers implementing ProTPL see an average twenty-five percent increase in OHI discovery. With ProTPL, Medicaid plans can save on claims that are the liability of other primary payers and effectively be the payer of last resort.

In July, Medicaid enrollment climbed to 84.5 million people. Due to the size of the program's population, Medicaid plans need to focus on innovative ways of identifying third-party liability, improving efficiency, and lowering costs. Presently, one of the best ways for Medicaid payers to do that is to adopt technology solutions like ProTPL, which will allow them to identify active third-party payers and satisfy TPL requirements.

Click here to learn more.

#Medicaid #COB #TPL #OIG #Report #Syrtis Solutions #Third-Party Liability

[sotirednews]

Personal Experience with Government Corruption: A Legit Insider's Look

jeff Menes

Fair warning up front: please don’t shoot the messenger! Although political corruption gets all the hype, mid-level Civil Service incompetence and corruption is equally if not more pervasive, but sadly enjoys complete freedom to thrive far far away from the media spotlight. But as a well-traveled former government journeyman with 10 years of civil experience, I can say with utmost confidence that mid-level government corruption is like a wild, raging fire that nobody is even trying to put out. I mean, just between us, I've seen the most outrageous examples of waste, fraud, and abuse that appear to be the norm throughout our fine government. Exciting, huh? In fact, based on my years with the DoD, Health and Human Services, smaller government orgs, and federal contractor businesses, I would conservatively estimate that the government wastes at least a gargantuan 30% of its operations. But who cares about that? Certainly not our esteemed officials!

The Ultimate Duo: Will and Ned’s Excellent Corruption Adventures 

Mid-level officials Will and Ned were like a knockoff version of the famous time-traveling dudes Bill and Ted, you know, those fun-loving guys always looking to take shortcuts? In fact, I’m sure these two managers pulled more strings than the fun-loving guitar playing duo could ever imagine. In particular, the pair of managerial misfits mysteriously changed position job titles to benefit the unqualified and unsuccessful, to the utter detriment of the agency's operations and the more qualified employees. Specifically, they renamed "Accounting" job titles to "Financial Analyst." roles. Although seemingly an innocent move to the government outsider, this move resulted in three absolutely unqualified candidates going from being repeatedly rejected for accounting roles to, all of a sudden and in rapid succession, being hired as a “Financial Analyst” —landing high-paying civilian positions with eventual $75-$100k salary increases, like wild, huh?.

No Downside to Corruption, Trust Us!

What's even better, Ned would then protect his toxic subordinate, Will, from any kind of consequences for his laundry list of malfeasances. Despite multiple losing lawsuits, a $250 million accounting blunder, and legendary inefficiencies in Will’s department (such as the 1980s style manner in which Will processed customer requests) these two retired geniuses remain unpunished to this day. Why would they be punished? All they did was bungle operations, waste taxpayer funds , and destroy careers. These instances of corruption clearly have no downside at all, trust us! They only lead to a loss of trust in officials, squandered resources, and a depleted talent base, no big deal. 

Transparency is Such a Hassle: Why Bother? 

Even though transparency at the mid-managerial level could significantly reduce instances of waste, fraud, and abuse, and even though government ops are eroding faster than a landslide, accountability is such a buzzkill when we can just keep things under wraps. Plus, given the inefficiencies currently plaguing the Office of the Inspector General, the inactivity of Congress, and the general apathy of the public, who cares about change anyway? 

Negative Impacts? What Negative Impacts? 

The negative impacts of government corruption are no biggie. The loss of trust in officials like Will and Ned only undermines transparency and accountability. And, again, who needs transparency and accountability anyway? It's not like the taxpayers really have anything to do with the way the government is run. Certainly taxpayers are extremely satisfied with the way things are currently going, as evidenced by all the violent riot footage, alarming polls, and growing animosity in the country..The misuse of taxpayer funds only affects essential programs and services, but is that really a big deal in uncertain times such as these?

Talented workers leaving the government out of frustration: A Win for Efficiency?

And let's not forget the unfortunate talent degradation of the government workforce. With the continued exodus of qualified individuals from the government, due in part to the Will’s and Ned’s of the world. we can only expect Uncle Sam and company to become more efficient, right? The manipulative and toxic behavior of corrupt officials, resulting in the destruction of careers, is surely no problem at all. Who needs career opportunities and the chance to make meaningful contributions to society when you can just be a pawn in the system? Surely a man who ranked in the top 1% of 1200 employees wouldn’t leave shortly after earning this distinction? 

Corruption is Impressive: A Ridiculous Situation! 

The whole situation is kind of ridiculous, but like, in a "wow this is impressive" kind of way, where it seems like the entire bureaucracy was set up to facilitate the dishonorable and protect the incompetent. The roots of government corruption are indeed protective and supportive for further abuse, like a family of sorts, fostering a sickly ecosystem of waste and inefficiency that poisons the entire government. That's so awesome, right? Why would we ever want things to change? 

Will Citizens and Lawmakers Demand Better

OK, enough with the sarcasm- this situation is beyond absurd. It's laughable, except it's not funny. It's infuriating. It's unacceptable. We can't just sit back and accept government corruption as the norm. It's time for the public to wake up and demand change. We need to hold our mid-level officials accountable and demand transparency in every level of government. We need to speak out and make sure our voices are heard. We need to make sure that the people we elect are actually working for us and not just for their own personal gain. We deserve a government that is efficient, effective, and trustworthy. We deserve officials who are honest, ethical, and accountable. And shame on us if we continue to let Will and Ned run amuck. It's time to wake up, people, and demand change.

#corruption #Civil Service #OIG #waste #mismanagement

[autodidacticpolymath-blog]

Dept. Homeland Security OIG Compendium of Disaster Preparedness Programs 6-6-2011

Dept. Homeland Security OIG Compendium of Disaster Preparedness Programs 6-6-2011

Click to access compdisasterprepprogs0611.pdf From Pg.10 DOD Mandated National Vigilant Guard for NORTHCOM requires states to conduct exercises test preparedness skills for emergency and disaster response- –DOD Civil-Military Medicine Force Health Protection and Readiness as military support for civilian authorities +[and the]- general public. –DOD giving Seminars on Transatlantic Civil…

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#DHS #DOD #OIG

[sacrainbowsitrep]

VA OIG: Veterans Prematurely Denied Compensation for Conditions That Could Be Associated with Burn Pit Exposure

VA OIG: Veterans Prematurely Denied Compensation for Conditions That Could Be Associated with Burn Pit Exposure

The review team examined three distinct samples of claimed conditions potentially related to burn pit exposure completed from May 1, 2020, to May 1, 2021, and found VBA could improve its processing and oversight. Though VBA staff nearly always made the correct decision in granting compensation for conditions identified as burn pit-related, the OIG found most denials were premature.

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#Department of Veterans Affairs #Office of the Inspector General #OIG #U.S. Department of Veterans Affairs #U.S. Military #VA OIG #VBA #Veterans #Veterans Benefits #Veterans Benefits Administration

[obsob]

u guys have no idea how hard i am gripping my brain to not buy Spring Green Frog

im sitting in my bedroom vibrating salivating biting clawing

#barks #oig ajBUGH AM n..snsm..NFROJGGIE...mksn .s

[ivyprism]

Me, casually chewing some food and drinking water, getting a notification: Hm? "@desktopdinosaur started following IvyPrism" Me:

#ASDF;PODSU;OIXCHODSIGHDF;OIG #WHAT #DSIOHFOSIHEIOG #*head in hands* #My precious mutuals

[hislop3]

OIG Issues Report on SNF Emergency Preparedness

Since the COVID pandemic, regulatory officials have escalated the review, via various audits, of SNF emergency preparedness. COVID highlighted the sporadic and often, non-existent preparations for disasters (natural and other) and disease outbreaks (pandemic or other) that existed with the SNF industry. In reality, the issues have been present for years but only regionally, highlighted by floods,…

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#CMS #Compliance #COVID #disaster planning #emergency preparedness #F-tag #guidance #Management #Medicare #Nursing Homes #OIG #pandemic #Payment #Policy #Quality #Regulation #Reimbursement #Report #SNF #Strategy #Washington

[pixiecaps]

oh just a secret between us ever since the nether update i have not survived over a minute in that place

#the oig hog thing is always there #and it kill me:(

[stairnaheireann]

#OTD in Irish History | 7 May:

#OTD in Irish History | 7 May:

1689 – James II arrives from exile in France and addresses the Irish Parliament. Thanking them for support, applauding their courage and vowing to “venture my life…in defence of your liberties”. Thus begins the events leading up to the Battle of the Boyne. 1689 – James II’s predominantly Catholic Irish parliament which is in session from this date until 18 July, implements various measures…

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#irelandinspires #irishhistory ireland #OTD #7 May #An Oige #Aran Island #Christy Moore #Co. Galway #History #History of Ireland #Inis Meáin #Ireland #Irish History #John MacBride #Lusitania #Today in Irish History

[cotyledonal]

I’m taking my driving test tomorrow I need y’all to send me good vibes

#my brain rn is like. oiuhgoihuoiuh[oig #jesus take the wheel

[sacrainbowsitrep]

VA OIG: Airborne Hazards & Open Burn Pit Registry Exam Process Needs Improvement

VA OIG: Airborne Hazards & Open Burn Pit Registry Exam Process Needs Improvement

The Veterans Health Administration (VHA) began collecting and recording data in the registry in May 2014 through an online questionnaire and free in-person exams. The OIG found many veterans did not complete the 140-item questionnaire, which is not clear and veteran-centric. Veterans also did not always realize they were responsible for scheduling their own exams.

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#Airborne Hazard Registry #Burn Pit Registry #Department of Veterans Affairs #Office of the Inspector General #OIG #U.S. Department of Veterans Affairs #U.S. Military #VA OIG #Veterans

[mysillyarthoard]

Oh yeah, I've been writing a fic using "Alone Among the Stars" (my favorite journaling game)

its only got three chapters rn and it's on the back burner but im getting pretty decent progress, so oim here

#alone among the stars #my fic #oig I hardly post on this blog