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Abbreviation
HHSOIG
Agencies
Department of Health & Human Services
Federal Agency
Yes
Location

United States

What to Report to the OIG Hotline
The U.S. Department of Health and Human Services (HHS) Office of Inspector General's (OIG) mission is to protect the integrity of HHS programs as well as the health and welfare of program beneficiaries. In doing so, we rely on complaints by HHS employees, contractors, subcontractors, grantees and subgrantees (i.e. whistleblowers) who report fraud, waste, abuse or mismanagement in HHS programs. We also review and investigate reports of whistleblower retaliation. If you would like more information on what kinds of complaints our OIG investigates, please visit our website at https://oig.hhs.gov/fraud/report-fraud/before-you-submit.asp. There you will find a list of things you should know before submitting a complaint to the OIG. If you would like more information on the types of whistleblowers protected by the OIG, please visit our whistleblower protection page at https://oig.hhs.gov/fraud/report-fraud/whistleblower.asp. If you are a whistleblower and wish to report fraud, waste, abuse or mismanagement in HHS programs, or you wish to report whistleblower retaliation, please visit our Hotline at https://oig.hhs.gov/fraud/report-fraud/index.asp.
What Not to Report to the OIG Hotline
  • Issues about Medicare policy, coverage, billing claims or appeals
  • Lost or stolen Medicare card
  • Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference
  • Allegations by employees or applicants concerning prohibited personnel practices; or Hatch Act violations
  • Appeals of administrative decisions made by HHS agencies, grantees or contractors, including Medicare payment decisions and contract or grant awards
  • Appeals of judicial decisions by federal or state courts involving HHS programs
  • Complaints of failure to safeguard medical information, i.e. HIPAA violations
  • Customer service complaints involving HHS employees, grantees or contractors
  • Allegations of identity theft unrelated to HHS programs
  • Disability fraud
  • SNAP/Food Stamp Fraud
  • Self-Disclosures

Medicare Compliance Review of Abbott Northwestern Hospital for 2013 and 2014 

2017
A-05-15-00043
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Abbott Northwestern Hospital (the Hospital) complied with Medicare billing requirements for 88 of the 162 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 74 claims, resulting in overpayments of $934,000 for...

California Did Not Bill Manufacturers for Rebates for Physician-Administered Drugs Dispensed to Enrollees of Some Medicaid Managed-Care Organizations 

2017
A-09-15-02035
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

From April 1 through December 31, 2010, the California Department of Health Care Services (State agency) did not always comply with Federal Medicaid requirements for billing manufacturers for rebates for physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations (MCOs...

Housing Works, Inc., Did Not Always Comply With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant 

2017
A-02-15-02001
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Housing Works, Inc., operating in Brooklyn, New York, did not comply with all applicable Federal requirements and grant terms related to its Affordable Care Act (ACA)-funded New Access Point grant. Specifically, a Housing Works subsidiary (1 of 14 subsidiary nonprofit organizations overseen by...

Audit of Medicaid Capitation Payments for Deceased Beneficiaries in Florida 

2017
A-04-15-06182
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Florida's Agency for Health Care Administration (State agency) did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any overpayments. Of the 124 capitation payments in our random sample selected from payments to beneficiaries whose...

Review of Massachusetts Medicaid Managed Care Program Potential Savings with Minimum Medical Loss Ratio 

2017
A-01-15-00505
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

A medical loss ratio (MLR) is the percentage of premium dollars an insurer spends to provide medical services and healthcare quality improvement activities for its members compared to the premium dollars it uses to pay for administrative expenses. This report is part of a series of Office of...

Visiting Nurse Service of New York Budgeted Costs That Were Not Appropriate and Claimed Some Unallowable Hurricane Sandy Disaster Relief Act Funds 

2017
A-02-14-02012
Disaster Recovery Report
Department of Health & Human Services OIG
Department of Health & Human Services

The Administration for Children and Families (ACF) awarded approximately $4.8 million in Disaster Relief Act funds to Visiting Nurse Service of New York (VNSNY), a not-for-profit home health care agency that operated Head Start and Early Head Start programs in New York, New York. The funds were for...

Hospitals Did Not Always Comply With Medicare Requirements for Reporting Cochlear Devices Replaced Without Cost 

2017
A-01-15-00508
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

Federal regulations require a payment reduction in the outpatient prospective payment system for the replacement of an implanted device if (1) the device is replaced without cost to the provider or the beneficiary, (2) the provider receives full credit for the cost of the replaced device, or (3) the...

New York Misallocated Costs to Establishment Grants for a Health Insurance Marketplace 

2017
A-02-14-02017
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The New York State Department of Health (State agency) did not always follow Federal requirements in allocating costs to its establishment grants for implementing a health insurance marketplace.

North Carolina Improperly Claimed Federal Reimbursement for Some Medicaid Nonemergency Transportation Services 

2017
A-04-15-04037
Audit
Department of Health & Human Services OIG
Department of Health & Human Services

The North Carolina Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for some nonemergency medical transportation (NEMT) services that did not comply with Federal or State requirements. Of the 200 sample items, 82 complied with Federal and State...

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