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HHSOIG - Rural Clinics

HHSOIG - Rural Clinics

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Published by T.L. Langford
HHS OIG audit of the Rural Clinic Program.
HHS OIG audit of the Rural Clinic Program.

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Published by: T.L. Langford on Apr 27, 2012
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04/27/2012

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Report Template Version = 03-01-05_rev.07
Department of Health and Human Services
OFFICE OF
INSPECTOR GENERAL
S
TATUS OF THE
R
URAL
H
EALTH
C
LINIC
P
ROGRAM
Daniel R. Levinson
Inspector General
August 2005
OEI-05-03-00170
 
Report Template Version = 03-01-05_rev.07
Office of Inspector General
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452,as amended, is to protect the integrity of the Department of Health and Human Services(HHS) programs, as well as the health and welfare of beneficiaries served by thoseprograms. This statutory mission is carried out through a nationwide network of audits,investigations, and inspections conducted by the following operating components:
Office of Audit Services
The OIG's Office of Audit Services (OAS) provides all auditing services for HHS, either byconducting audits with its own audit resources or by overseeing audit work done by others. Audits examine the performance of HHS programs and/or its grantees and contractorsin carrying out their respective responsibilities and are intended to provide independentassessments of HHS programs and operations in order to reduce waste, abuse, andmismanagement and to promote economy and efficiency throughout the department.
Office of Evaluation and Inspections
The OIG's Office of Evaluation and Inspections (OEI) conducts management andprogram evaluations (called inspections) that focus on issues of concern to thedepartment, the Congress, and the public. The findings and recommendations containedin the inspections reports generate rapid, accurate, and up-to-date information on theefficiency, vulnerability, and effectiveness of departmental programs. The OEI alsooversees State Medicaid fraud control units, which investigate and prosecute fraud andpatient abuse in the Medicaid program.
Office of Investigations
The OIG's Office of Investigations (OI) conducts criminal, civil, and administrativeinvestigations of allegations of wrongdoing in HHS programs or to HHS beneficiariesand of unjust enrichment by providers. The investigative efforts of OI lead to criminalconvictions, administrative sanctions, or civil monetary penalties.
Office of Counsel to the Inspector General
The Office of Counsel to the Inspector General (OCIG) provides general legal services toOIG, rendering advice and opinions on HHS programs and operations and providing alllegal support in OIG's internal operations. The OCIG imposes program exclusions andcivil monetary penalties on health care providers and litigates those actions within thedepartment. The OCIG also represents OIG in the global settlement of cases arisingunder the Civil False Claims Act, develops and monitors corporate integrity agreements,develops compliance program guidances, renders advisory opinions on OIG sanctions tothe health care community, and issues fraud alerts and other industry guidance.
 
Report Template Version = 03-01-05_rev.07
Δ
 
EXECUTIVE SUMMARY
OBJECTIVE
To follow up on previous Office of Inspector General (OIG)recommendations concerning the appropriate location of Rural HealthClinics (RHC).
BACKGROUND
In 1996, OIG and the Government Accountability Office (GAO) issuedreports that raised concerns about the inappropriate growth andlocation of RHCs. Both offices recommended changes that would ensurethat RHCs are located in areas that would otherwise be underserved.Because of these reports, Congress, as part of the Balanced Budget Actof 1997 (BBA), amended section 1861(aa)(2) the Social Security Act toremove the permanent designation of RHCs and require timely reviewof shortage-designation areas. However, to date, the Centers forMedicare & Medicaid Services (CMS) has no regulations implementingthe BBA’s required changes.To be eligible for RHC status, a clinic must be located in a “rural” and“underserved” area. The Rural Health Clinic Services Act of 1977 (the Act) defines “rural” as an area that the Bureau of the Census (Census)categorizes as a nonurbanized area. An “underserved” area is one thatthe Health Resources and Services Administration (HRSA) designatedas medically underserved or experiencing a physician shortage. Forshortage areas to be eligible under the RHC Program, the BBA requiredthat HRSA review and update these areas every 3 years.Under Medicare and Medicaid, RHCs receive cost-based reimbursementor a capped amount that is normally higher than a typical physicianoffice visit. Payments for RHC services continue to increase andexceeded $630 million in calendar year 2002.
FINDINGS
Two hundred seventy-nine RHCs are located in areas that HRSA hasnot designated as shortage areas or that Census has designated asurbanized areas.
Sixty-one percent (169) of these RHCs are located inareas that HRSA has not designated as shortage areas. The remaining39 percent (110) are located in urbanized areas defined by Census.Under the BBA, these RHCs would no longer maintain theirdesignations as RHCs unless they receive exceptions as essentialproviders. CMS issued final regulations for the exception process.
OEI-05-03-00170 S
TATUS OF THE
R
URAL
H
EALTH
C
LINIC
P
ROGRAM
i

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