Department of Health & Human Services OIG

This study continues OIG's body of work examining overpayments made by Medicare. Overpayments can be identified by a number of key players including providers and Medicare contractors. Recovering overpayments is critical to reducing improper payments in the Medicare program. Past OIG work found that...

The nursing home complaint process is a critical safeguard to protect vulnerable residents of nursing homes. CMS relies on the States' respective survey agencies to serve as the front-line responders to address health and safety concerns raised by residents, their families, and nursing home staff...

The Inspector General Act of 1978 (Public Law 95-452), as amended, requires that the Inspector General report semiannually to the head of the Department and the Congress on the activities of the office during the 6-month periods ending March 31 and September 30. The semiannual reports are intended...

This spring edition of the Semiannual Report to Congress covers OIG activities from October 2016 through March 2017. Historically, about 80 percent of OIG's resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization and content of the report.

The California Department of Social Services (Social Services), Community Care Licensing Division (licensing division), did not (1) accurately record or investigate one complaint, (2) complete investigations in a timely manner, (3) refer priority I and II complaints (the most serious) to the...

Integrated Health Administrative Services, Inc. (Integrated), (located in Mamaroneck, New York) complied with certain Medicare Part B requirements for 91 of the 112 claims that we sampled. However, the remaining 21 claims did not comply with certain Medicare requirements. On the basis of our sample...

Federal regulations require each State to ensure that Medicaid beneficiaries have necessary transportation to and from medical providers. During the period October 1, 2012, through September 30, 2013, the Minnesota Department of Human Services (State agency) claimed at least $6.4 million for...

The Massachusetts Department of Children and Families (State agency) generally complied with applicable Federal and State regulations for ensuring that children who were Title IV-E eligible and residing in foster care congregate care group homes received medical services during calendar year 2015 as...

Medicare Compliance Review of Parkridge Medical Center, Inc., for 2014 and 2015 Parkridge Medical Center, Inc. (the Hospital), located in Chattanooga, Tennessee, complied with Medicare billing requirements for 88 of 100 inpatient claims we reviewed. However, the Hospital did not fully comply with...

The summarized results of our individual Medicare contractor reviews (issued between June 2014 and September 2015) revealed that for the period October 2003 through March 2011, Medicare contractors did not always refer Medicare cost reports that qualified for reconciliation, and the Centers for...