Department of Health & Human Services OIG

Several of the Consumer Operated and Oriented Plans (CO-OPs) that were operating at the beginning of 2016 are no longer viable or sustainable. Specifically, 5 of the 11 CO-OPs operating on January 1, 2016, had ceased or planned to cease operations by the end of the 2016 plan year, and each of the...

This memorandum alerts the Centers for Medicare & Medicaid Services (CMS) to the preliminary results of our ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the Office of Inspector General (OIG)...

Accredo Health Group, Inc. (which is located in Memphis, Tennessee, and has pharmacies across the United States) complied with Medicare requirements when billing for inhalation drugs. Specifically, all 100 claim lines in our sample complied with the requirements. Consequently, this report has no...

Medicare Part B provides for the coverage of outpatient therapy services, including occupational, physical, and speech therapy. Previous OIG reports identified unallowable claims for these services. Fox Rehabilitation (Fox), headquartered in New Jersey, was among the largest providers of outpatient...

Kentucky did not always determine Medicaid eligibility in accordance with Federal and State requirements. For our sample of 120 beneficiaries, Kentucky correctly determined eligibility for 113 beneficiaries, but it did not meet Federal and State requirements for eligibility determinations of 7...

HHS oversees States' administration of various Federal programs, including Medicaid. State agencies are required to establish appropriate computer system security requirements and conduct biennial reviews of computer system security used in the administration of State plans for Medicaid and other...

Not all of the direct medical service costs that the Texas Health and Human Services Commission (State agency) claimed for Medicaid School Health and Related Services (SHARS) were reasonable, adequately supported, and otherwise allowable in accordance with applicable Federal and State requirements...

TrailBlazer Health Enterprises, LLC, claimed $228,000 of unallowable Medicare pension costs on its Incurred Cost Proposals for calendar years 2008 through 2013.

Congress authorized the President's Emergency Plan for AIDS Relief (PEPFAR) to receive $48 billion in funding for the 5-year period beginning October 1, 2008, to assist foreign countries in combating HIV/AIDS, tuberculosis, and malaria. Congress authorized additional funds to be appropriated through...

This summary report provides an overview of the results of our audit of the information system general controls over the New Mexico Medicaid eligibility systems. It does not include specific details of the vulnerabilities that we identified because of the sensitive nature of the information. We have...