Department of Health & Human Services OIG

On the basis of our review of 100 sampled deficiencies, we determined that the Missouri Department of Health and Senior Services verified nursing homes' correction of deficiencies identified during surveys in calendar year 2014 in accordance with Federal requirements. Accordingly, this report...

The Mississippi Division of Medicaid (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. The State agency used statistically invalid random moment sampling (RMS) in allocating costs to Medicaid, and it did not maintain adequate...

Alta Bates Medical Center, located in Berkeley, California, did not comply with all Medicare requirements for reporting wage data in its fiscal year 2010 Medicare cost report. We estimated that, as a result, in 2014 Medicare overpaid the Medical Center $154,000 and overpaid 32 other hospitals in 2...

Jackson-Madison County General Hospital (the Hospital), located in Jackson, Tennessee, complied with Medicare billing requirements for 141 of the 200 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 59 claims...

Medicare acute-care hospitals must report wage data annually to the Centers for Medicare & Medicaid Services (CMS). Wage data include wages, associated hours, and wage-related costs. CMS uses the wage data to calculate acute-care hospital wage indexes, which measure geographic area labor market...

The Massachusetts Medicaid program (MassHealth) did not safeguard Medicaid Management Information System (MMIS) data and supporting systems in accordance with Federal requirements. Specifically, MassHealth had vulnerabilities related to security management, configuration management, system software...

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (Lerner College) inappropriately drew down some Disaster Relief Act funds and did not implement effective internal controls to monitor Disaster Relief Act funds. Of the $588,000 in Disaster Relief Act funds that we...

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote correct coding by providers and to prevent Medicare payments for improperly coded services. The NCCI edits include procedure-to-procedure edits that define pairs of HCPCS/Current...

Blue Cross Blue Shield Association did not claim allowable pension costs of $362,000 for Medicare reimbursement for fiscal years 2011 through 2015.

Blue Cross Blue Shield Association, a terminated Medicare contractor, overstated the Medicare segment pension assets by $1 million as of September 30, 2015. In addition, Blue Cross Blue Shield Association understated Medicare's share of the Medicare segment excess pension assets by $161,000 as of...