Department of Health & Human Services

His House Children's Home, Inc. (His House), an Unaccompanied Alien Children (UAC) grantee responsible for caring for children in Office of Refugee Resettlement (ORR) custody, met safety standards for the care and release of children in its custody. However, some UAC case files were missing evidence...

OIG has conducted numerous audits, evaluations, and investigative work involving personal care services (PCS) and offered recommendations for improving program oversight. Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect...

Texas Medicaid did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Specifically, Texas Medicaid paid managed care organizations $1.8 million ($1 million Federal share) for capitation payments between...

Providers incorrectly billed diagnosis code 260 for Kwashiorkor for inpatients who did not have the disease. We reviewed the medical records for 2,145 inpatient claims at 25 providers and found that all but 1 claim incorrectly included the diagnosis code for Kwashiorkor, resulting in overpayments in...

A limited number of prescription drugs—generally those that are injected or infused in physicians' offices or hospital outpatient settings—are covered under Medicare Part B. With certain exceptions, Part B does not cover drugs that are self-administered by patients, including drugs administered by...

New Jersey did not follow Federal regulations and CMS guidance when it developed its payment rates for Medicaid school-based services and, as a result, claimed $300.5 million in unallowable costs. New Jersey claimed an additional $306.2 million in reimbursement using payment rates developed with...

Ernst & Young (EY), under its contract with the HHS Office of Inspector General (OIG), audited the second quarter for fiscal year (FY) 2017 to determine HHS's compliance with the Digital Accountability and Transparency Act (DATA Act; P.L. No. 113-101) and related guidance.

CMS usually selected DMEPOS suppliers, calculated the sampled Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) single-payment amounts (SPAs), and monitored suppliers in accordance with its established procedures and applicable Federal requirements. We determined that CMS...