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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

CDC Reimbursed Contractors for Some Unallowable World Trade Center Health Program Administrative Costs

2019
A-02-16-02012
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The World Trade Center Health Program (WTCHP) was established in January 2011 by the James Zadroga 9/11 Health and Compensation Act of 2010 (Zadroga Act). The WTCHP is administered by the Centers for Disease Control and Prevention (CDC). CDC incurred WTCHP administrative costs by contracting with...

Factsheet: Nevada's Oversight of Opioid Prescribing and Monitoring of Opioid Use

2019
A-09-18-01004
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

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

New Mexico Did Not Always Appropriately Refund the Federal Share of Recoveries from Managed Care Organizations

2019
A-06-18-09001
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Of the $374 million in managed care organization (MCO) recoveries, New Mexico appropriately refunded the Federal share for $359 million. However, New Mexico underreported the Federal share for the remaining $15 million by $4.4 million because (1) it incorrectly calculated the Federal share of...

Missouri Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services

2019
A-07-17-03219
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The Missouri Department of Social Services (State agency) claimed Federal Medicaid reimbursement of at least $6 million (almost $3.8 million Federal share) for unallowable targeted case management (TCM) payments during Federal fiscal years 2014 and 2015. The State agency paid TCM providers and...

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2018

2019
OEI-03-19-00030
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...

CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met

2019
A-05-16-00043
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

According to Federal law, to be eligible for coverage of posthospital extended care services, a Medicare beneficiary must be an inpatient in a hospital for not less than 3 consecutive calendar days (3-day rule) before being discharged from the hospital. CMS improperly paid 65 of the 99 skilled...

Although the Centers for Disease Control and Prevention Resolved Nearly All Audit Recommendations, It Did Not Always Do So in Accordance With Federal Timeframe Requirements

2019
A-07-17-03226
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), did not always resolve audit recommendations in a timely manner during Federal fiscal years (FYs) 2015 and 2016. Specifically, CDC resolved 855 of the 888 audit recommendations that were...

Factsheet: New Hampshire's Oversight of Opioid Prescribing and Monitoring of Opioid Use

2019
A-01-18-01501
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

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

Factsheet: Nebraska's Oversight of Opioid Prescribing and Monitoring of Opioid Use

2019
A-07-18-06080
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

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

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