Department of Health & Human Services

Wisconsin Physicians Service Insurance Corporation claimed $4.4 million in unallowable administrative costs on its Medicare Part B final administrative cost proposals for fiscal years 2009, 2010, and 2011.

Wisconsin Physicians Service Insurance Corporation claimed $4.8 million in unallowable administrative costs on its Medicare Part B final administrative cost proposals for fiscal years 2009, 2010, and 2011.

Boulevard Health Care, Inc. (Boulevard), operating in Puerto Rico, claimed Medicare reimbursement for outpatient therapy services that did not comply with certain Medicare requirements. Of the 100 claims in our random sample, 57 complied with Medicare requirements, but 43 did not. We estimated that...

The South Carolina Department of Social Services' (State agency) monitoring did not always ensure that homes that received funding form the Child Care and Development Fund (CCDF) funds complied with State guidelines or requirements related to the health and safety of children. Of the 20 homes we...

Naples Community Hospital (the Hospital), located in Naples, Florida, complied with Medicare billing requirements for 134 of the 225 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 91 claims, resulting in net...

The Wisconsin Department of Health Services (State agency) improperly claimed at least $74,000 in enhanced Federal Medicaid reimbursement for non-family-planning services for the period October 1, 2010, through September 30, 2012.

Boca Raton Regional Hospital, Inc. (the Hospital), located in Florida, complied with Medicare billing requirements for 161 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 50 claims, resulting in...

The Patient Protection and Affordable Care Act (ACA) established standards for the amount of premium revenue that certain commercial health insurers and Medicare Advantage plans can spend on costs other than healthcare-related expenses. These standards are known as the medical loss ratio (MLR)...

Kindred Hospital of Central Ohio (the Hospital), in Mansfield, Ohio, did not comply with Medicare requirements for billing Kwashiorkor on any of the 77 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no...

Most Medicaid payments that the Oklahoma Health Care Authority made to providers for full vials of Herceptin from January 1, 2012, through December 31, 2014, were correct. Of the 85 claim lines reviewed, 82 were correct and 3 were incorrect.