Department of Health & Human Services

The New York State Department of Health (State agency) did not always pay electronic health record (EHR) incentive payments in accordance with Federal and State requirements. The State agency made incorrect EHR incentive payments to two hospitals totaling $175,000. Because the incentive payment is...

States generally determined Children's Health Insurance Program (CHIP) eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State CHIP agency can use findings (e.g., income) from eligibility determinations made by a different...

States generally determined Medicaid eligibility using the Express Lane Eligibility (ELE) option in accordance with Federal requirements. Under the ELE option, a State Medicaid agency can use findings (e.g., income) from eligibility determinations made by a different agency within the State to...

CMS had policies and procedures to ensure that payments were not made for Medicare services ostensibly rendered to deceased individuals. These policies and procedures generally ensured that CMS did not make improper payments when its data systems indicated at the time a claim was processed that the...

Both the Centers for Medicare & Medicaid Services' (CMS) policies and procedures to ensure that payments are not made for Medicare services rendered to incarcerated beneficiaries and its planned revisions to those policies and procedures did not comply with Medicare requirements.

The North Carolina Division of Medical Assistance (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. The State agency used statistically invalid random moment sampling (RMS) in allocating costs to Medicaid, and it did not maintain...

Noridian Healthcare Solutions, LLC, a subsidiary of Noridian Mutual Insurance Company, did not claim $144,000 of allowable pension or postretirement benefit plan costs for Medicare reimbursement during fiscal years 2006 through 2008.

The Colorado Department of Health Care Policy and Financing (HCPF) had not implemented adequate information system general controls over the Colorado Medicaid eligibility determination and claims processing systems to fully comply with Federal requirements. The vulnerabilities that we identified...

Bergan Mercy Medical Center (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 219 of the 224 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining five claims, resulting...

Michigan Department of Health and Human Services (the State agency) did not always comply with Federal requirements when using a random moment time study (RMTS) to claim direct medical service costs related to Medicaid school-based health services (SBHS). Specifically, the RMTS methodology did not...