Department of Health & Human Services OIG

Payments for outpatient intensity-modulated radiation therapy (IMRT) planning services did not comply with Medicare billing requirements. Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning. The...

Medicare payments to providers for emergency ambulance transports did not comply or potentially did not comply with Federal requirements. Specifically, Medicare made improper and potentially improper payments totaling $1.9 million: (1) improper payments of $975,154 for transports to destinations...

New Hampshire implemented most 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...

Illinois did not comply with Federal waiver and State requirements in overseeing centers that serve vulnerable adults who receive services through the Elderly Waiver program. We determined that 18 of the 20 centers we reviewed did not comply with 1 or more State requirements. Specifically, we found...

HHS oversees States’ use of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other Federal...

Some of the bonus payments that Alaska received for the audit period were not allowable in accordance with Federal requirements. Most of the data used in Alaska’s bonus payment calculations were in accordance with Federal requirements. However, Alaska overstated its fiscal years 2009 through 2013...

The Patient Protection and Affordable Care Act (ACA) established marketplaces to allow individuals and small businesses to shop for health insurance in all 50 States and the District of Columbia. The Centers for Medicare & Medicaid Services (CMS) operates the Federal marketplace and is responsible...

In 2016, OIG called attention to significant growth in spending for compounded drugs (customized medications tailored to meet the needs of individual patients). Specifically, OIG found that Medicare Part D spending for compounded drugs grew by 625 percent from 2006 to 2015 and spending for topical...

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 mandates that OIG compare ASPs with average manufacturer...

Administrative costs Wisconsin Physicians Service Insurance Corporation claimed on its fiscal year 2013 final administrative cost proposal were generally allowable and in accordance with its Medicare contract and applicable Federal regulations. Of the $29.2 million reviewed, we accepted $27.7...