Department of Health & Human Services OIG

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...

We conducted this audit because OIG had identified ensuring the safety and effectiveness of medical devices and fostering a culture of cybersecurity as top management challenges for HHS. We also considered public and Congressional interest in medical device cybersecurity risks to patients and the...

New York claimed Federal Medicaid reimbursement for some Assertive Community Treatment (ACT) services that did not comply with Medicaid requirements. Specifically, of the 100 claims in our random sample, 87 claims complied with Medicaid requirements, but 13 claims did not.

Prior OIG audits found that hospitals in six Medicare Administrative Contractor (MAC) jurisdictions counted residents (including interns) as more than one full-time equivalent (FTE) and, as a result, received excess Medicare graduate medical education (GME) reimbursement. This report summarizes the...

The U.S. Congress authorized the President’s Emergency Plan for AIDS Relief (PEPFAR) to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Congress authorized additional funds to be...

Florence Crittenton Services of Orange County, Inc. (Crittenton), an Unaccompanied Alien Children (UAC) program grantee located in Fullerton, California, did not always claim expenditures in accordance with applicable Federal requirements. Of the 135 sampled expenditure transactions that Crittenton...

Professional Clinical Laboratory, Inc. (ProLab) generally did not comply with Medicare requirements for billing travel allowances. Specifically, of the 100 travel allowance claim lines in our stratified random sample, 35 claim lines complied with Medicare requirements and 65 claim lines did not...

The Office of Inspector General (OIG) must review a statistically valid sample of the spending data submitted by the Department of Health and Human Services (HHS) in accordance with the Digital Accountability and Transparency Act (DATA Act; P.L. No. 113-101). The DATA Act expands the reporting...

Wisconsin made 1,654 capitation payments totaling $589,478 ($347,822 Federal share) on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with these capitation payments were deceased.

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not...