Department of Health & Human Services OIG

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) directly affects both the Children's Health Insurance Program and Medicaid. Under CHIPRA, Congress appropriated $3.225 billion for qualifying States to receive performance bonus payments (bonus payments) for Federal fiscal...

Ohio makes capitation payments to five managed care organizations (MCOs) for beneficiaries in the Medicaid Managed Care (MMC) program. Previous OIG reviews in other States identified Medicaid payments made on behalf of ineligible beneficiaries and duplicative monthly capitation payments.

The opioid crisis is a public health emergency. There were 47,600 opioid-related overdose deaths in the United States in 2017. As part of its efforts to address this crisis, OIG has assessed opioid use in Medicare Part D nationwide and in specific areas, such as the Appalachian region. This data...

For a covered outpatient drug to be eligible for Federal Medicaid reimbursement, the manufacturer must enter into a rebate agreement administered by the Centers for Medicare & Medicaid Services (CMS) and pay quarterly rebates to the States. Previous OIG reviews found that States did not always bill...

Ensuring the accuracy of manufacturer-reported average manufacturer prices (AMPs) and best prices (BPs) is vital given that these prices are the primary benchmarks that the Federal Government uses to calculate the rebates and discounts available to Medicaid and certain safety-net providers. In the...

This evaluation examines data and oversight related to Part D pharmacy rejections and coverage denials that, when issued for avoidable or inappropriate reasons, can lead to delays in beneficiary access to needed drugs. Part D is an optional benefit that helps beneficiaries pay for medically...

Because ambulatory surgery centers (ASCs) often perform complex medical procedures, including invasive surgeries under general anesthesia, we examined how Medicare ensures that ASCs meet minimum health and safety requirements through its State survey process. Most ASCs (known as nondeemed ASCs)...

A prior OIG review found that Medicare made improper and potentially improper payments of $1.9 million to providers for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities (SNFs) with dates of service from calendar years (CYs) 2014 through 2016. As part...

Medicaid plays a critical role in providing behavioral healthcare. Nationally, Medicaid is the single largest payor for behavioral healthcare. In addition, Medicaid enrollees experience a higher rate of behavioral health disorders-which includes both mental health disorders and substance use...

In June 2018, OIG published a data brief Increases in Reimbursement for Brand-Name Drugs in Part D (OEI-03-15-00080). This data brief found that even after accounting for rebates, Part D reimbursement for brand-name drugs increased 62 percent from 2011 to 2015. Subsequently, OIG received a...