Department of Health & Human Services OIG

Medicare Part D paid $168 billion for drugs for 46.8 million Medicare beneficiaries in 2018. Despite its size, Part D does not have the same protections against pharmacy fraud that other parts of Medicare have.

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that, in 2017, 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.

We reviewed the oversight of opioid prescribing and the monitoring of opioid use in Kentucky. This factsheet shows Kentucky's responses to our questionnaire covering five categories related to its approach to addressing the opioid epidemic: policies and procedures, data analytics, programs, outreach...

Under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) operates the federally facilitated marketplace (Federal marketplace) in States that chose not to operate their own marketplaces. Prior OIG audits of the Federal marketplace covering the 2014 coverage year determined...

In October 2015, the Centers for Medicare & Medicaid Services (CMS) approved New York's Community First Choice option (CFCO). The approval allowed New York to receive an additional 6 percent of Federal Medical Assistance Percentage (FMAP), referred to as "enhanced FMAP," for eligible home and...

The U.S. Department of Health and Human Services (HHS) provides funding through numerous programs that support and provide assistance to low-income families. Our prior audit (A-04-14-04026) of Wateree Community Actions, Inc. (Wateree), for fiscal years (FYs) 2012 and 2013, found that Wateree...

Previous OIG audits found that States had improperly paid Medicaid managed care organizations (MCOs) capitation payments on behalf of deceased beneficiaries. We conducted a similar audit of the Indiana Family and Social Services Administration, which administers the Medicaid program.

The Child Care and Development Block Grant Act (CCDBG Act) of 2014 added new requirements for States that received funding from the Child Care and Development Fund (CCDF) to conduct comprehensive criminal background checks on staff members and prospective staff members of childcare providers every 5...

The Centers for Medicare and Medicaid Services (CMS) requested that OIG audit a mail-order pharmacy's Medicare Part D Eligibility Verification Transactions (E1 transactions). To address CMS's request, we conducted this audit of E1 transactions, which included the requested provider's transactions...

In 2016, the Centers for Medicare & Medicaid Services (CMS) updated its life safety and emergency preparedness regulations to improve protections for all Medicare and Medicaid beneficiaries, including those residing in long-term-care facilities (commonly referred to as nursing homes). Updates...