Department of Health & Human Services OIG

This summary report provides an overview of the results of our audit of the information security controls at New York's health insurance exchange, New York State of Health (New York marketplace). It does not include specific details of the vulnerabilities that we identified because of the sensitive...

The Digital Accountability and Transparency Act of 2014 (the DATA Act, P.L. No. 113-101) requires that Federal agencies report financial and payment data in accordance with data standards established by the Department of Treasury (Treasury) and the Office of Management and Budget (OMB). The DATA Act...

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

TrustSolutions, LLC, claimed unallowable pension costs of $62,000 for Medicare reimbursement for calendar years 2007 through 2009.

With respect to Medicaid patient days, Wisconsin Physicians Service (WPS) did not properly settle Medicare cost reports submitted by Indiana hospitals for Medicare disproportionate share hospital (DSH) payments in accordance with Federal requirements. The 48 selected providers improperly claimed a...

The Indiana Family and Social Services Administration (State agency) did not always use the correct Federal Medical Assistance Percentages (FMAPs) when processing Medicaid claim adjustments reported on the CMS-64. Of the 23,693,045 Medicaid claim adjustments we reviewed, we determined that 23,274...

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a New York City dentist that did not comply with certain Federal and State requirements. Of the 100 randomly selected claims that we reviewed, 88 claims complied with Federal and State...

The North Dakota Department of Human Services' (State agency) claims for Medicaid reimbursement for Targeted Case Management (TCM) services provided and paid for during Federal fiscal years (FYs) 2013 and 2014 were not always in accordance with Federal requirements. Specifically, the State agency...

The Arizona Department of Health Services, Division of Licensing Services, Bureau of Long-Term Care Licensing (State agency), did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year (CY) 2014 in accordance with Federal requirements. For the 100...

In eight previous audits, we identified instances in which State Medicaid agencies (State agencies) did not always comply with Federal requirements in administering their Home and Community-Based Services (HCBS) waiver programs. Specifically, we found that State agencies did not always exclude...