Department of Health & Human Services

The Alabama Medicaid Agency (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. It claimed these costs without submitting for Division of Cost Allocation review its public assistance cost allocation plan (CAP) and certain...

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (State agency), did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group...

Houston Methodist Hospital (the Hospital) located in Houston, Texas, complied with Medicare billing requirements for 111 of the 159 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 48 claims, resulting in net...

Cornerstone Hospital of Southwest Louisiana (the Hospital) in Sulphur, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 52 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of...

Christian Hospital (the Hospital) (operating in Saint Louis, Missouri) complied with Medicare billing requirements for 95 of the 199 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 104 claims, resulting in...

The New Jersey Department of Human Services (State agency) did not adequately oversee its Medicaid nonemergency medical transportation brokerage program to ensure that (1) vehicles used to transport beneficiaries met State standards, (2) drivers were licensed and qualified, (3) prior authorizations...

The University of Tennessee Medical Center (the Hospital) complied with Medicare billing requirements for 219 of the 236 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 17 claims, resulting in...

The President's Emergency Plan for AIDS Relief (PEPFAR) was authorized to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Additional funds were authorized to be appropriated through 2018.

Dominican Hospital, located in Santa Cruz, California, did not comply with all Medicare requirements for reporting wage data used by CMS to calculate the fiscal year 2014 wage index. We estimated that, as a result, in 2014 Medicare overpaid the hospital $67,000 and overpaid two other hospitals in...

International Institute of Sleep, Inc. (the Institute), an Independent Diagnostic Testing Facility based in Deerfield Beach, Florida, billed Medicare for polysomnography services that did not meet Medicare billing requirements for all 100 randomly selected beneficiaries with 130 corresponding lines...