Department of Health & Human Services OIG

Bergan Mercy Medical Center (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 219 of the 224 outpatient and inpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining five claims, resulting...

Michigan Department of Health and Human Services (the State agency) did not always comply with Federal requirements when using a random moment time study (RMTS) to claim direct medical service costs related to Medicaid school-based health services (SBHS). Specifically, the RMTS methodology did not...

The World Trade Center Health Program (WTCHP) is administered by CDC through its National Institute for Occupational Safety and Health (NIOSH). Under the WTCHP, pharmacy benefits and medical services are provided to eligible responders and survivors with certified health conditions related to the...

We alerted CMS to the preliminary results of our ongoing review of the costs Medicare incurred because of recalled or defective medical devices. Our ongoing review shows that the lack of medical device-specific information in the claims data impedes the ability of CMS to readily identify and...

The Centers for Medicare & Medicaid Services (CMS) had policies and procedures to ensure that payments were not made for Medicare services rendered to unlawfully present beneficiaries in accordance with Federal requirements, but it did not always follow those policies and procedures. When CMS's data...

Sleep Health Center (Sleep Health), based in Fort Myers, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries that we reviewed, Sleep Health billed Medicare claims for polysomnography...

Although the California Department of Health Care Services (State agency) made Medicaid electronic health record (EHR) incentive program payments to eligible hospitals, it did not always make these payments in accordance with Federal requirements. Specifically, from October 1, 2011, through December...

The Minnesota's Health Insurance Marketplace (MNsure) had implemented security controls, policies, and procedures intended to prevent vulnerabilities in its Web applications (Web site), database, and other supporting information systems. However, it did not always comply with Federal and State...

The Virginia Department of Medical Assistance Services (State agency) did not always use the correct Federal medical assistance percentage (FMAP) when processing claim adjustments reported on Form CMS-64. The State agency used the current FMAP on the date the adjustment was made. In doing so, the...

The Department of Vermont Health Access, part of Vermont's Agency of Human Services (State agency) did not always follow Federal requirements for (1) allocating costs to its establishment grants for implementing a health insurance marketplace and (2) drawing down establishment grant funds.