Department of Health & Human Services OIG

Mount Sinai Hospital (the Hospital) located in New York, New York, complied with Medicare billing requirements for 151 of the 261 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 110 claims for the audit...

For Federal fiscal years 2010 through 2013, the California Department of Health Care Services (State agency) claimed $58.3 million in Federal reimbursement for Medicaid overpayments that it made to providers who were determined to be bankrupt or out of business (uncollectible overpayments). The...

The Florida Agency for Health Care Administration (State agency) did not always suspend Medicaid payments to providers that had credible fraud allegation cases in accordance with the Social Security Act. Of the 95 cases that we reviewed, the State agency applied a good-cause exception not to suspend...

All 100 of the New Jersey Department of Human Services' (State agency) sampled claims for Federal Medicaid reimbursement for partial hospitalization services did not comply with Federal and State requirements, and 92 contained more than 1 deficiency. Partial hospitalization services are provided on...

If a State taxes Medicaid managed care organizations (MCOs), the tax must extend to both Medicaid and non-Medicaid MCOs (i.e., be broad based) to comply with Federal requirements. At the time of our audit in 2016, two States did not meet Federal requirements stating that taxes on MCOs be broad based...

The Illinois Department of Healthcare and Family Services used correct Federal medical assistance percentages when processing Medicaid claim adjustments reported on the CMS-64 for both public and private providers. Accordingly, this report contains no recommendations.

Over half of the Medicaid payments that Ohio's Department of Medicaid made to providers for full vials of Herceptin were incorrect. Of the 248 line items reviewed, 135 (54 percent) were incorrect and resulted in overpayments of about $142,000 ($91,000 Federal share). The 113 remaining line items...

The Wisconsin Department of Health Services (State agency) did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. The State agency did not invoice manufacturers for rebates associated with $3 million ($1.8 million Federal...

The University of Arkansas for Medical Sciences Medical Center (the Hospital) complied with Medicare billing requirements for 54 of the 70 inpatient claims and all 60 outpatient claims. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 16 inpatient...

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...