Department of Health & Human Services OIG

Claims for outpatient physical therapy services provided by a physical therapy practice (the practice), with offices located in Southern California, did not comply with Medicare requirements. Specifically, of the 100 beneficiary days in our random sample, the practice properly claimed Medicare...

Connect for Health Colorado (Colorado marketplace), the health insurance exchange established by the State of Colorado under the provisions of the Patient Protection and Affordable Care Act, did not expend $9.7 million of Federal establishment grant funds in accordance with Federal requirements...

Most of the New Jersey Department of Human Services' (State agency) claims for Federal Medicaid reimbursement for partial care services did not comply with Federal and State requirements. The partial care services program provides individualized outpatient clinic services (e.g., group and individual...

The Ohio State University monitored subrecipients and claimed costs as a subrecipient in accordance with National Institutes of Health grant polices and Federal regulations. Accordingly, this report contains no recommendations.

NorthShore University HealthSystem (the Hospital) complied with Medicare billing requirements for 97 of the 190 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 93 claims, resulting in overpayments of $625...

University of Mississippi Medical Center (the Hospital) (operating in Jackson, Mississippi) complied with Medicare billing requirements for 137 of the 217 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 80...

The University of Louisville did not always claim selected costs charged directly to HHS awards in accordance with Federal regulations and, where appropriate, NIH guidelines. In our sample of 120 salary transactions, 102 were allowable but 18 were not. In addition, in our sample of 100 nonsalary...

For the period January 1 through December 31, 2013, the Virginia Department of Medical Assistance Services, Division of Health Care Services (State agency), did not fully comply with Federal Medicaid requirements for billing manufacturers for some rebates for physician-administered drugs dispensed...

South Carolina's Medicaid managed care program would not have saved any Medicaid funds in calendar year (CY) 2014 if the State agency had (1) required its Medicaid managed care plans to meet the minimum medical loss ratio (MLR) standard similar to the Federal standards for certain private health...

The North Mississippi Medical Center (the Hospital) (operating in Tupelo, Mississippi) complied with Medicare billing requirements for 158 of the 237 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 79 claims...