Department of Health & Human Services

During a prior review of a Medicaid-funded mental health program in New York State (the State), we observed that some providers were paid more than the Medicaid base rate for certain services. These providers participated in the State's Comprehensive Outpatient Program Services (COPS) and Community...

The Vanderbilt University Medical Center (the Hospital), located in Nashville, Tennessee, complied with Medicare billing requirements for 172 of the 245 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 73...

A physical therapist in South Texas claimed Medicare reimbursement for outpatient physical therapy services that did not meet Medicare reimbursement requirements in calendar years 2012 and 2013. Specifically, of the 100 beneficiary claim days in our random sample, the therapist properly claimed...

The West Carroll Care Center (the Nursing Home) (operating in Oak Grove, Louisiana) did not always provide service to its residents in accordance with their care plans, as required by Federal regulations, before the residents were hospitalized with urinary tract infections. Specifically, the Nursing...

For inpatient claims with certain Medicare Severity Diagnosis-Related Groups (MS-DRGs), Medicare requires that beneficiaries have received 96 or more hours of mechanical ventilation. For 137 of the 200 claims we reviewed, Medicare payments to hospitals complied with Medicare requirements; the...

The data in CDC's property system were neither accurate nor complete. Of the 250 items we sampled from the property system, we located 245. CDC had classified the remaining five items as missing. We also found 14 items costing $3.1 million that were not barcoded or accurately recorded in the...

Our ongoing audit of FDA's food recall program found that FDA did not have an efficient and effective food recall initiation process that helps ensure the safety of the Nation's food supply. Specifically, FDA did not have policies and procedures to ensure that firms or responsible parties initiated...

The Washington Health Benefit Exchange (Washington marketplace), Washington State's health insurance exchange, implemented security controls over its Web site and database, but improvements are needed to fully comply with Federal requirements and to increase protection of personally identifiable...

We reviewed the Centers for Medicare & Medicaid Services' (CMS) administration of the Pioneer Accountable Care Organization (ACO) Payment Model (Pioneer Model).

The Utah Department of Health, Division of Medicaid and Health Financing (State agency), did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. The State agency did not invoice manufacturers for rebates associated with $6...