Department of Health & Human Services OIG

Ernst & Young (EY), under its contract with the HHS Office of Inspector General (OIG), audited the second quarter for fiscal year (FY) 2017 to determine HHS's compliance with the Digital Accountability and Transparency Act (DATA Act; P.L. No. 113-101) and related guidance.

CMS usually selected DMEPOS suppliers, calculated the sampled Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) single-payment amounts (SPAs), and monitored suppliers in accordance with its established procedures and applicable Federal requirements. We determined that CMS...

This review is part of a series of hospital compliance reviews. Using computer matching, data mining, and data analysis techniques, we identified hospital claims that were at risk for noncompliance with Medicare billing requirements. For calendar year 2015, Medicare paid hospitals $163 billion...

The Minnesota Elderly Waiver program (the program) funds home- and community-based services for people aged 65 and older who are eligible for medical assistance and require the level of care provided in a nursing home but choose to live in the community, such as at a licensed family adult foster...

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) directly affects both the Children's Health Insurance Program and Medicaid. Under CHIPRA, Congress appropriated $3.225 billion for qualifying States to receive bonus payments to offset the costs of increased enrollment of...

Southeast Arkansas Community Action Corporation (Southeast) did not always operate its Head Start program in accordance with Federal regulations and did not always manage and account for Federal funds. Specifically, Southeast (1) had ineffective controls and accountability over its assets, (2) used...

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) directly affects both the Children's Health Insurance Program and Medicaid. Under CHIPRA, Congress appropriated $3.2 billion for qualifying States to receive bonus payments to offset the costs of increased enrollment of...

The New York State Department of Health, Division of Nursing Homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities Surveillance (State agency) did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year (CY) 2014 in...

Although Oklahoma received crossover claim adjustments, it did not have any policies and procedures for processing adjustments to Medicare crossover claims. As a result, Oklahoma did not recoup amounts due from providers or pay amounts owed to providers when an adjustment to a crossover claim...

For a covered outpatient drug to be eligible for Federal reimbursement under the Medicaid program's drug rebate requirements, manufacturers must pay rebates to the States for the drugs. However, a prior OIG review found that States did not always invoice and collect all rebates due for drugs...