Department of Health & Human Services OIG

The Centers for Medicare & Medicaid Services (CMS) oversees implementation of health insurance provisions for the Affordable Care Act and works with States to establish marketplaces, which evaluate individuals' eligibility for qualified health plans (QHPs) and insurance affordability programs (i.e...

Although the Oklahoma Department of Human Services (State agency) performed the required onsite monitoring at all 22 group homes, this onsite monitoring did not ensure that foster care group homes complied with State licensing and Federal requirements related to the health and safety of children in...

Washington did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Washington properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did...

Hawaii did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Hawaii properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did not bill...

Each year roughly 48 million people in the United States get sick, 128,000 are hospitalized, and 3,000 die of foodborne diseases. To protect against foodborne illnesses, FDA inspects food facilities to ensure both food safety and compliance with regulations. Congress passed the Food Safety...

Medicare did not appropriately pay acute-care hospitals any of the $51.6 million for outpatient services that we reviewed. In addition, beneficiaries were held responsible for unnecessary deductibles and coinsurance of $14.4 million paid to the acute-care hospitals for outpatient services. Generally...

The Wisconsin Department of Children and Families (DCF) did not always comply with Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program requirements and the terms and conditions of the program's grants, resulting in unallowable expenditures totaling $275,175. Specifically, for the...

When Nevada billed manufacturers for rebates for physician-administered and pharmacy drugs, it did so correctly. However, Nevada estimated that it did not bill for rebates of $520,137 ($327,624 Federal share) for physician-administered and pharmacy drugs that were eligible for rebates. In addition...

Sierra Nevada Memorial Hospital (the Hospital), located in Grass Valley, California, generally complied with Medicare requirements for reporting wage data in its fiscal year 2014 Medicare cost report. However, errors in reporting wage data did occur. We estimated that, as a result, Medicare overpaid...

Blue Cross Blue Shield Association claimed $68,605 of unallowable fiscal intermediary contract Medicare postretirement benefit costs on its Final Administrative Cost Proposals for fiscal years 2011 through 2015.