Department of Health & Human Services

Although the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), has made significant progress in the timely resolution of audit recommendations since our previous review (of Federal fiscal years (FYs) 2006 and 2007), CMS did not always resolve audit...

In the Spring of 2018, the Department of Justice and Department of Homeland Security (DHS) implemented a "zero-tolerance policy" for certain immigration offenses. As a result, DHS separated large numbers of alien families, with adults being held in Federal detention while their children were...

From January 1, 2015, through March 31, 2017 (audit period), Kelley Medical Equipment and Supply, LLC (Kelley Medical), which is located in Durant, Oklahoma, did not always comply with Medicare requirements when billing for selected orthotic braces (i.e., back, knee, and ankle-foot braces). For 24...

While New York implemented some background check requirements established under the Child Care and Development Block Grant (CCDBG) Act, it had not fully implemented all of the new criminal background check requirements as of October 1, 2018-its deadline for implementing the requirements. New York...

Rhode Island did not ensure its Medicaid managed-care organizations (MCOs) complied with Federal and State requirements prohibiting Medicaid payments to providers for inpatient hospital services related to treating certain provider-preventable conditions (PPCs). PPCs are certain reasonably...

Some of the bonus payments that Virginia received for the audit period were not allowable in accordance with Federal requirements. Most of the data used in Virginia's bonus payment calculations were in accordance with Federal requirements. However, Virginia overstated its current enrollments in its...

Of the 120 sampled outpatient claims totaling $415,513, First Coast Service Options, Inc. (First Coast) made payments for hyperbaric oxygen (HBO) therapy in accordance with Medicare requirements for 5 claims. However, First Coast made payments for HBO therapy that did not comply with Medicare...

The National Institute of Transplantation (NIT), an independent histocompatibility laboratory located in Los Angeles, California, did not fully comply with Medicare requirements for reporting tissue-typing costs and revenues on its fiscal year (FY) 2012 Medicare cost report. Of the 186 cost...

The Penobscot Indian Nation (Penobscot Nation) did not meet all Federal and Tribal health and safety requirements for the quality of health care at the Penobscot Nation Health Department (PNHD). Specifically, we found that PNHD did not have a physician who provided the medical direction for the...

Inadequate oversight at both the Centers for Medicare & Medicaid Services (CMS) and the State Medicaid agency (State agency) level created vulnerabilities in State agencies' use of random moment timestudies (RMTS) as a basis to allocate and claim Federal Medicaid reimbursement for costs associated...