Department of Health & Human Services OIG

The Missouri Department of Social Services (State agency) did not always comply with Federal and State requirements when making payments under its Child Care subsidy program for State fiscal years 2014 and 2015. Client attendance records were not adequately documented for 124 of the 128 provider...

Pine Bluff Jefferson County Economic Opportunities Commission (Pine Bluff) did not always claim Head Start grant costs that were allowable and allocable in accordance with Federal regulations. Specifically, Pine Bluff claimed $392,094 of unsupported non-Federal share; $214,372 in costs that did not...

His House Children's Home, Inc. (His House), an Unaccompanied Alien Children (UAC) grantee responsible for caring for children in Office of Refugee Resettlement (ORR) custody, met safety standards for the care and release of children in its custody. However, some UAC case files were missing evidence...

OIG has conducted numerous audits, evaluations, and investigative work involving personal care services (PCS) and offered recommendations for improving program oversight. Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect...

Texas Medicaid did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Specifically, Texas Medicaid paid managed care organizations $1.8 million ($1 million Federal share) for capitation payments between...

Providers incorrectly billed diagnosis code 260 for Kwashiorkor for inpatients who did not have the disease. We reviewed the medical records for 2,145 inpatient claims at 25 providers and found that all but 1 claim incorrectly included the diagnosis code for Kwashiorkor, resulting in overpayments in...

A limited number of prescription drugs—generally those that are injected or infused in physicians' offices or hospital outpatient settings—are covered under Medicare Part B. With certain exceptions, Part B does not cover drugs that are self-administered by patients, including drugs administered by...

New Jersey did not follow Federal regulations and CMS guidance when it developed its payment rates for Medicaid school-based services and, as a result, claimed $300.5 million in unallowable costs. New Jersey claimed an additional $306.2 million in reimbursement using payment rates developed with...