Department of Health & Human Services

Claims for outpatient physical therapy services provided by a physical therapy practice (the practice), located in Yuba City, California, did not comply with Medicare requirements. Specifically, of the 100 beneficiary days in our random sample, the practice properly claimed Medicare reimbursement...

TrustSolutions, LLC, claimed unallowable pension costs of $62,000 for Medicare reimbursement for calendar years 2007 through 2009.

With respect to Medicaid patient days, Wisconsin Physicians Service (WPS) did not properly settle Medicare cost reports submitted by Indiana hospitals for Medicare disproportionate share hospital (DSH) payments in accordance with Federal requirements. The 48 selected providers improperly claimed a...

The Indiana Family and Social Services Administration (State agency) did not always use the correct Federal Medical Assistance Percentages (FMAPs) when processing Medicaid claim adjustments reported on the CMS-64. Of the 23,693,045 Medicaid claim adjustments we reviewed, we determined that 23,274...

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a New York City dentist that did not comply with certain Federal and State requirements. Of the 100 randomly selected claims that we reviewed, 88 claims complied with Federal and State...

The North Dakota Department of Human Services' (State agency) claims for Medicaid reimbursement for Targeted Case Management (TCM) services provided and paid for during Federal fiscal years (FYs) 2013 and 2014 were not always in accordance with Federal requirements. Specifically, the State agency...

The Arizona Department of Health Services, Division of Licensing Services, Bureau of Long-Term Care Licensing (State agency), did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year (CY) 2014 in accordance with Federal requirements. For the 100...

In eight previous audits, we identified instances in which State Medicaid agencies (State agencies) did not always comply with Federal requirements in administering their Home and Community-Based Services (HCBS) waiver programs. Specifically, we found that State agencies did not always exclude...

From July 1, 2012, through June 30, 2013, the Virginia Department of Medical Assistance Services (State agency) paid $78.2 million to 73 eligible hospitals in Virginia for Medicaid EHR incentive payments. We reviewed hospitals that received an incentive payment totaling $1 million or more. There...

Most Medicare payments for chiropractic services did not comply with Medicare requirements. On the basis of our sample results, we estimated that $358.8 million, or approximately 82 percent, of the $438.1 million paid by Medicare for chiropractic services was unallowable. These overpayments occurred...