Department of Health & Human Services

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based...

OIG administers the MFCU grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The primary purpose...

Up to 80 percent of children enter foster care with significant mental health needs. For children with mental health needs, psychotropic medications (i.e., medication used to treat clinical psychiatric symptoms or mental disorders such as depression, bipolar disorder, schizophrenia, and anxiety...

Effective in 2018, the Medicare program changed the way it sets payment rates for clinical diagnostic laboratory (lab) tests. CMS replaced payment rates with new rates based on charges in the private health care market. This is the first reform in 3 decades to Medicare's payment system for lab tests...

Previous OIG reviews of Medicaid administrative costs found that several States did not always claim administrative costs according to Federal requirements. As part of a Medicaid risk assessment, we noted that Virginia claimed $342.6 million ($220 million Federal share) for Medicaid administrative...

For calendar years 2015 and 2016, Liberty Medical, LLC, (Liberty), which is located in Port St. Lucie, Florida, did not always comply with Medicare requirements when billing for inhalation drugs. Of the 100 claim lines in our sample, 94 complied with the requirements; however, the remaining 6 claim...

WakeMed Raleigh Campus (the Hospital), located in Raleigh, NC, complied with Medicare billing requirements for 187 of the 263 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 76 claims, resulting in net overpayments of...

The Open Payments program promotes transparency by making available to the public the financial relationships that physicians and teaching hospitals have with applicable manufacturers and group purchasing organizations. Although these financial relationships may provide important opportunities to...

Payments for outpatient intensity-modulated radiation therapy (IMRT) planning services did not comply with Medicare billing requirements. Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning. The...

Medicare payments to providers for emergency ambulance transports did not comply or potentially did not comply with Federal requirements. Specifically, Medicare made improper and potentially improper payments totaling $1.9 million: (1) improper payments of $975,154 for transports to destinations...