Department of Health & Human Services

New York claimed Federal Medicaid reimbursement for some Assertive Community Treatment (ACT) services that did not comply with Medicaid requirements. Specifically, of the 100 claims in our random sample, 87 claims complied with Medicaid requirements, but 13 claims did not.

Prior OIG audits found that hospitals in six Medicare Administrative Contractor (MAC) jurisdictions counted residents (including interns) as more than one full-time equivalent (FTE) and, as a result, received excess Medicare graduate medical education (GME) reimbursement. This report summarizes the...

The U.S. Congress authorized the President’s Emergency Plan for AIDS Relief (PEPFAR) to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Congress authorized additional funds to be...

Florence Crittenton Services of Orange County, Inc. (Crittenton), an Unaccompanied Alien Children (UAC) program grantee located in Fullerton, California, did not always claim expenditures in accordance with applicable Federal requirements. Of the 135 sampled expenditure transactions that Crittenton...

Professional Clinical Laboratory, Inc. (ProLab) generally did not comply with Medicare requirements for billing travel allowances. Specifically, of the 100 travel allowance claim lines in our stratified random sample, 35 claim lines complied with Medicare requirements and 65 claim lines did not...

The Office of Inspector General (OIG) must review a statistically valid sample of the spending data submitted by the Department of Health and Human Services (HHS) in accordance with the Digital Accountability and Transparency Act (DATA Act; P.L. No. 113-101). The DATA Act expands the reporting...

Wisconsin made 1,654 capitation payments totaling $589,478 ($347,822 Federal share) on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with these capitation payments were deceased.

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not...

Wisconsin did not comply with Federal waiver and State requirements in overseeing centers that serve vulnerable adults who receive services through the Family Care program (the program). All 20 of the centers we reviewed did not comply with State certification requirements. In total, we found 208...

Mobile Infirmary Medical Center (the Hospital) complied with Medicare billing requirements for 87 of the 100 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 13 claims, resulting in net overpayments of $163,104.