Department of Health & Human Services

The Centers for Medicare & Medicaid Services (CMS) relies extensively on contractors to carry out its basic mission and spends billions of dollars each year in contracts for a variety of goods and services. A contract is closed once the contractor has completed contract requirements and the...

Medicare Part B pays a set amount to health care providers who furnish drugs to its beneficiaries. Certain eligible health care providers-generally, those that serve a disproportionate share of needy patients-are allowed to purchase drugs using the 340B Drug Discount Program, thereby receiving...

Annually, the Office of Inspector General (OIG) prepares a summary of the most significant management and performance challenges facing the Department of Health and Human Services. We refer to this summary as the Top Management Challenges (TMC). The TMCs and the Department's progress toward...

The Office of Inspector General (OIG) has identified 10 top management and performance challenges facing the Department of Health and Human Services (HHS) as it strives to fulfill its mission "to enhance the health and well-being of Americans by providing effective health and human services and by...

The Office of Inspector General (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 onsite reviews of all...

Medicaid is the primary source of dental coverage for children in low-income families and provides access to dental care for approximately 37 million children. However, access to dental care for children with Medicaid has been a longstanding concern. When children lack dental care, untreated decay...

CMS implemented the "2-midnight" policy in fiscal year (FY) 2014. The policy establishes that inpatient payment is generally appropriate if physicians expect beneficiaries' care to last at least 2-midnights; otherwise, outpatient payment would generally be appropriate. CMS implemented the 2-midnight...

Improper payments to healthcare providers constitute a significant vulnerability for Medicaid, costing an estimated $17.5 billion in fiscal year 2014. Automated claims processing safeguards called "edits" are critical program integrity tools that are available to State Medicaid agencies to prevent...

Since the Part D program went into effect in 2006, the Office of Inspector General (OIG) has had ongoing concerns about abuse and diversion of Part D drugs. In June 2015, OIG released a data brief, Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D...

Clinical diagnostic laboratory (lab) tests provide information integral to preventing, diagnosing, and treating disease in millions of Medicare beneficiaries every year. The Protecting Access to Medicare Act of 2014 (PAMA) requires reform of Medicare's payment system for lab tests-the first such...