Department of Health & Human Services

Housing Works, Inc., operating in Brooklyn, New York, did not comply with all applicable Federal requirements and grant terms related to its Affordable Care Act (ACA)-funded New Access Point grant. Specifically, a Housing Works subsidiary (1 of 14 subsidiary nonprofit organizations overseen by...

Florida's Agency for Health Care Administration (State agency) did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any overpayments. Of the 124 capitation payments in our random sample selected from payments to beneficiaries whose...

A medical loss ratio (MLR) is the percentage of premium dollars an insurer spends to provide medical services and healthcare quality improvement activities for its members compared to the premium dollars it uses to pay for administrative expenses. This report is part of a series of Office of...

The Administration for Children and Families (ACF) awarded approximately $4.8 million in Disaster Relief Act funds to Visiting Nurse Service of New York (VNSNY), a not-for-profit home health care agency that operated Head Start and Early Head Start programs in New York, New York. The funds were for...

The Minnesota marketplace did not always allocate costs for establishing a health insurance marketplace and expend establishment grant funds in accordance with Federal requirements.

Federal regulations require a payment reduction in the outpatient prospective payment system for the replacement of an implanted device if (1) the device is replaced without cost to the provider or the beneficiary, (2) the provider receives full credit for the cost of the replaced device, or (3) the...

The New York State Department of Health (State agency) did not always follow Federal requirements in allocating costs to its establishment grants for implementing a health insurance marketplace.

The North Carolina Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services that did not comply with Federal or State requirements. Of the 200 sample items, 82 complied with Federal and State...

This summary report provides an overview of the results of our audit of the information security controls at New York's health insurance exchange, New York State of Health (New York marketplace). It does not include specific details of the vulnerabilities that we identified because of the sensitive...

The Digital Accountability and Transparency Act of 2014 (the DATA Act, P.L. No. 113-101) requires that Federal agencies report financial and payment data in accordance with data standards established by the Department of Treasury (Treasury) and the Office of Management and Budget (OMB). The DATA Act...