Department of Health & Human Services

This report fulfills for 2019 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA). The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible individuals (i.e...

Congress created the 340B Drug Pricing Program to assist providers serving vulnerable patient populations by allowing them to purchase outpatient drugs at discounted prices. For drugs dispensed to Medicare Part D beneficiaries for payment under the Part D program, manufacturers may pay rebates based...

This report describes specific instances of harm to hospice beneficiaries and identifies vulnerabilities in CMS's efforts to prevent and address harm. In past work, the Office of Inspector General (OIG) raised a number of concerns about the care provided to Medicare beneficiaries. As part of a...

The Office of Inspector General (OIG) has identified significant vulnerabilities in the Medicare hospice benefit and found that hospices did not always provide needed services to beneficiaries and sometimes provided poor quality care. Hospice care can provide great comfort to beneficiaries, their...

The Medicaid "health home" option allows States to create programs that provide care coordination and care management for beneficiaries with chronic health conditions. Health homes are not physical spaces. Rather, they are a health care model in which providers work together to coordinate and manage...

During a prior review, we determined that New York claimed Medicaid reimbursement for home and community-based services (HCBS) under a Medicaid waiver program that did not comply with Federal requirements.New York's Nursing Home Transition and Diversion (NHTD) is an HCBS waiver program. Our...

An effective provider enrollment screening process is an important tool for preventing Medicaid fraud. It plays a vital role in identifying unscrupulous providers and preventing them from enrolling in Medicaid. The Federal Government requires States to conduct risk based screening activities as part...

The Nation has been grappling with an opioid crisis for several years. In 2017 alone, there were 47,600 opioid-related overdose deaths in the United States. It continues to be a public health emergency. OIG has been tracking opioid use in Medicare during this crisis, particularly since 2016. OIG has...

Semiannual Report to Congress

The Refugee Act of 1980 created the Refugee Resettlement Program (RRP) to provide for the effective resettlement of refugees and to assist them in achieving economic self-sufficiency after arriving in the United States. The Act provides Federal grants to States for cash and medical assistance...