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Abbreviation
HHSOIG
Agencies
Department of Health & Human Services
Federal Agency
Yes
Location

United States

What to Report to the OIG Hotline
The U.S. Department of Health and Human Services (HHS) Office of Inspector General's (OIG) mission is to protect the integrity of HHS programs as well as the health and welfare of program beneficiaries. In doing so, we rely on complaints by HHS employees, contractors, subcontractors, grantees and subgrantees (i.e. whistleblowers) who report fraud, waste, abuse or mismanagement in HHS programs. We also review and investigate reports of whistleblower retaliation. If you would like more information on what kinds of complaints our OIG investigates, please visit our website at https://oig.hhs.gov/fraud/report-fraud/before-you-submit.asp. There you will find a list of things you should know before submitting a complaint to the OIG. If you would like more information on the types of whistleblowers protected by the OIG, please visit our whistleblower protection page at https://oig.hhs.gov/fraud/report-fraud/whistleblower.asp. If you are a whistleblower and wish to report fraud, waste, abuse or mismanagement in HHS programs, or you wish to report whistleblower retaliation, please visit our Hotline at https://oig.hhs.gov/fraud/report-fraud/index.asp.
What Not to Report to the OIG Hotline
  • Issues about Medicare policy, coverage, billing claims or appeals
  • Lost or stolen Medicare card
  • Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference
  • Allegations by employees or applicants concerning prohibited personnel practices; or Hatch Act violations
  • Appeals of administrative decisions made by HHS agencies, grantees or contractors, including Medicare payment decisions and contract or grant awards
  • Appeals of judicial decisions by federal or state courts involving HHS programs
  • Complaints of failure to safeguard medical information, i.e. HIPAA violations
  • Customer service complaints involving HHS employees, grantees or contractors
  • Allegations of identity theft unrelated to HHS programs
  • Disability fraud
  • SNAP/Food Stamp Fraud
  • Self-Disclosures

Many Medicaid-Enrolled Children Who Were Treated for ADHD Did Not Receive Recommended Followup Care

2019
OEI-07-17-00170
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder with symptoms of inattention, hyperactivity, and impulsivity. The Department of Health and Human Services publishes national quality measures that outline timeframes for followup care for children with ADHD...

HHS Did Not Always Efficiently Plan and Coordinate Its International Ebola Response Efforts

2019
A-04-16-03567
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The U.S. Department of Health and Human Services (HHS) is the U.S. Government's principal agency for protecting the health of all Americans and providing essential human services. Included in that role is a charge to respond to international epidemics that could threaten the United States.

Pennsylvania Did Not Ensure That Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions

2019
A-03-16-00205
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Pennsylvania did not ensure that its managed-care organizations complied with Federal and State requirements prohibiting Medicaid payments to providers for inpatient hospital services related to treating certain provider-preventable conditions. For our audit period, we identified that managed-care...

The Administration for Community Living Failed To Conduct Any of the Required Onsite Compliance Reviews of Independent Living Programs

2019
A-05-18-00034
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

In June 2017, HHS-OIG received a hotline complaint alleging that the Administration for Community Living (ACL) was not conducting its required oversight of independent living programs. We performed this audit to determine whether ACL appropriately oversaw the activities of independent living...

States' Payment Rates Under the Child Care and Development Fund Program Could Limit Access to Child Care Providers

2019
OEI-03-15-00170
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

The Child Care and Development Fund (CCDF) program, for which fiscal year (FY) 2018 Federal funding totaled $8.2 billion, provides child care subsidies for 1.4 million eligible children. CCDF program payments, which are administered by States, allow eligible low income parents to work or pursue...

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2019

2019
OEI-03-19-00050
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act (the Act) mandates that OIG compare ASPs with average...

Georgia Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths

2019
A-04-15-06183
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Effective June 1, 2006, Georgia implemented Georgia Families, a managed care program between Georgia and private health plans to provide benefits and health care services to Medicaid, PeachCare for Kids members, Planning for Healthy Babies enrollees, and Georgia Families 360° members. As of July...

New York Achieved Program Goals For Enhancing Its Prescription Drug Monitoring Program

2019
A-02-18-02001
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

According to the Centers for Disease Control and Prevention (CDC), opioids were involved in more than 47,000 deaths in 2017, and opioid deaths were 6 times higher in 2017 than in 1999. CDC has awarded funding to States to address the nonmedical use of prescription drugs and to address opioid...

IHS Needs To Improve Oversight of Its Hospitals' Opioid Prescribing and Dispensing Practices and Consider Centralizing Its Information Technology Functions

2019
A-18-17-11400
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Prescription opioids continue to contribute to the opioid overdose epidemic. A prior OIG audit identified high volumes of opioid purchases in IHS communities. In addition, the prior OIG audit of two IHS hospitals determined that IHS did not have adequate information technology (IT) security controls...

Group Health Incorporated Understated Its Cash Balance Pension Plan Medicare Segment Pension Assets as of January 1, 2011

2019
A-07-19-00557
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Group Health Incorporated, a subsidiary of EmblemHealth, LLC, understated its Cash Balance Plan Medicare segment pension assets as of January 1, 2011, by $366,763.

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