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Group Health Incorporated, a subsidiary of EmblemHealth, LLC, overstated its Local 153 Pension Plan Medicare segment pension assets as of January 1, 2015, by $2.4 million.
Group Health Incorporated, a subsidiary of EmblemHealth, LLC, understated its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare segment pension assets as of January 1, 2015, by $432,584.
Historically, only certain groups of individuals who had incomes and assets below certain thresholds were eligible for Medicaid (traditional coverage groups). After the passage of the Patient Protection and Affordable Care Act (ACA), some beneficiaries remained eligible under these traditional...
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...
The Kentucky Home and Community-Based Services Waiver program (the program) funds home and community-based services for people aged 65 and older and individuals with disabilities aged 21 to 64 who are eligible for medical assistance and require the level of care provided in a nursing home but choose...
A previous OIG report found that, in 2009 and 2010, Delaware did not comply with Federal requirements to report all Medicaid overpayment collections. The report had five recommendations that were still unimplemented as of June 30, 2017.Our objective was to determine whether Delaware implemented...
This resource guide explains our approach to using claims data to identify incidents of potential abuse or neglect of vulnerable populations. The guide synthesized the methodologies that OIG developed in our extensive work on identifying unreported critical incidents, particularly those involving...
Medicare spending is expected to exceed $1.5 trillion by 2028, more than double the $708 billion in spending in 2017. To help control Medicare spending, while promoting high-quality healthcare, CMS has been implementing alternative payment models that reward providers for the quality and value of...
The U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), did not resolve audit recommendations in a timely manner during Federal fiscal years (FYs) 2015 and 2016. SAMHSA resolved 104 of the 292 audit recommendations that were...
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 reviews of all Units and prepares public reports based...
