Department of Health & Human Services OIG

Wisconsin did not comply with Federal waiver and State requirements in overseeing centers that serve vulnerable adults who receive services through the Family Care program (the program). All 20 of the centers we reviewed did not comply with State certification requirements. In total, we found 208...

Mobile Infirmary Medical Center (the Hospital) complied with Medicare billing requirements for 87 of the 100 inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 13 claims, resulting in net overpayments of $163,104.

Some chiropractic services that Etheredge billed were not allowable in accordance with Medicare requirements. Of the 100 chiropractic services in our sample, 67 were allowable in accordance with Medicare requirements. However, the remaining 33 were not allowable: 31 services were medically...

Nevada implemented some of the new criminal background check requirements established under the Child Care and Development Block Grant Act. However, certain criminal background check requirements for childcare providers remained unimplemented as of March 1, 2018, and significant challenges may delay...

The U.S. Department of Health and Human Services (HHS), Indian Health Service (IHS), did not always resolve audit recommendations in a timely manner during Federal fiscal years (FYs) 2015 and 2016. Specifically, IHS resolved 138 of the 651 recommendations that were outstanding during FYs 2015 and...

A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for MAOs to inappropriately deny access to services and payment in an attempt to increase their profits. An MAO that inappropriately denies authorization of services for beneficiaries, or...

Heartland Human Care Services, Inc. (Heartland), generally met applicable safety standards for the care and release of children in its custody. Heartland met State licensure requirements and requirements for inspections, performed adequate oversight, and followed guidance when reviewing background...

Our prior reviews have found that some hospitals did not comply with Medicare coverage and documentation requirements for inpatient rehabilitation facilities (IRFs). CMS’s Comprehensive Error Rate Testing (CERT) program found that the error rate for IRFs increased, ranging from 9 percent in 2012 to...

The Fort Peck Assiniboine and Sioux Tribes (known collectively as the Fort Peck Tribes) are federally recognized Native American tribes located in Montana. For Federal fiscal years (FYs) 2011 through 2015, the Fort Peck Tribes did not administer $436,765 of Low-Income Home Energy Assistance Program...

First Coast Service Options, Inc., overstated Medicare’s share of the Medicare segment pension liabilities by $6.6 million.