Department of Health & Human Services

Wisconsin's Federal Medicaid withdrawals during FYs 2010 through 2012 did not fully comply with Federal and State regulations. The Wisconsin Department of Health Services (State agency) properly withdrew $13.6 billion of the $13.7 billion obtained in Federal Medicaid funds. However, the State agency...

The internal controls of the Kentucky Health Benefit Exchange (Kentucky marketplace) were generally effective in ensuring that individuals were enrolled in qualified health plans (QHPs) according to Federal requirements. However, we identified deficiencies with maintenance of identity-proofing...

Total Sleep Management, Inc. (Total Sleep), an Independent Diagnostic Testing Facility, based in Orlando, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries, Total Sleep billed...

Altru Hospital (the Hospital) (operating in Grand Forks, North Dakota) complied with Medicare billing requirements for 241 of the 253 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 12 claims, resulting in...

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based...

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based...

OHRP receives and responds to alleged violations of protections for human subjects in research conducted or supported by the Department of Health and Human Services (HHS). Employees of research institutions (e.g., researchers or study coordinators) with insider knowledge of the circumstances can...

Drug diversion, counterfeiting, and the importation of unapproved drugs may result in potentially dangerous drugs entering the drug supply chain, posing a threat to public health and safety. To enhance drug supply chain security, the Drug Supply Chain Security Act (DSCSA) requires trading partners...

State Medicaid agencies (Medicaid agencies) are required to suspend payments for health care items and services when there is a credible allegation of fraud against the provider, unless "good cause" exists not to suspend payment. Using payment suspensions, when appropriate, is important to protect...

Statutorily mandated rebates, which include both basic rebates and inflation-indexed rebates (additional rebates owed when drug prices rise faster than inflation), amount to a substantial percentage of spending on Medicaid prescription drugs. Medicare does not have the authority to collect rebates...