Department of Health & Human Services OIG

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 $4.0 million that we reviewed, we accepted $3.9...

OIG is committed to ensuring that beneficiaries receive quality care and to safeguarding the hospice benefit. OIG has produced numerous evaluations and audits of the hospice program, including in-depth looks at specific levels of care and settings. OIG has also conducted criminal and civil...

First Coast Service Options, Inc., claimed $43,835 of unallowable Medicare pension costs for calendar years 2008 through 2010.

First Coast Service Options, Inc., did not claim $1.06 million of allowable Medicare Supplement Executive Retirement Plan costs for calendar years 2008 through 2010.

The Centers for Medicare & Medicaid Services (CMS) did not always provide accurate Medicaid unit rebate offset amounts (UROAs) to State Medicaid agencies (State agencies) during the period January 1, 2010, through December 31, 2014, in accordance with Federal guidance. (Under the Medicaid drug...

The Iowa Department of Human Services (State agency) complied with most Federal requirements prohibiting Medicaid payments for inpatient hospital services related to treating certain provider-preventable conditions (PPCs), because its automated system edits identified claims submitted by the...

The Missouri Department of Social Services (State agency) did not comply with Federal and State requirements prohibiting Medicaid payments for inpatient hospital services related to treating certain provider-preventable conditions (PPCs), which are certain reasonably preventable conditions caused by...

Medicare made improper payments of $8.7 million to providers for nonemergency ambulance transports to destinations not covered by Medicare, including the identified ground mileage associated with the transports. Medicare covers ambulance transports to only certain destinations, such as hospitals...

The Protecting Access to Medicare Act of 2014 (PAMA) reformed the way the Medicare program sets payment rates for clinical diagnostic laboratory tests (lab tests) under Part B. CMS's new rates, which took effect on January 1, 2018, are based on lab-reported data: rates paid by private payers such as...

The U.S. Department of Health and Human Services (HHS), Administration for Children and Families (ACF), did not always resolve audit recommendations in a timely manner during Federal fiscal years (FYs) 2015 and 2016. Specifically, ACF resolved 1,570 of the 2,248 audit recommendations that were...