Department of Health & Human Services OIG

Blue Cross Blue Shield of South Carolina overstated its allocable postretirement benefit costs by $7.4 million for calendar years 2006 through 2011. We performed this audit in conjunction with two related audits (A-07-16-00483 and A-07-16-00484).

Postretirement benefit costs totaling $4,000 that CGS Administrators, LLC, claimed for Medicare reimbursement for fiscal year 2011 were reasonable and allowable. We performed this audit in conjunction with two related audits (A-07-16-00483 and A-07-16-00485).

Palmetto Government Benefits Administrator, LLC, a subsidiary of Blue Cross Blue Shield South Carolina, claimed unallowable postretirement benefit costs of $665,000 for Medicare reimbursement for fiscal years 2005 through 2011. We performed this audit in conjunction with two related audits (A-07-16...

Although the Washington State Health Care Authority (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 31...

Illinois improperly claimed $149,000 in Federal Medicaid reimbursement over a 2-year period for inpatient hospital services related to treating certain provider-preventable conditions. In addition, Illinois improperly reduced Federal Medicaid reimbursement by $52,000 for inpatient hospital services...

From July 1, 2012, through June 30, 2014, the Idaho Department of Health and Welfare claimed $4.3 million in Federal Medicaid reimbursement for inpatient hospital services related to certain provider-preventable conditions, some portion of which was unallowable.

The Washington State Health Care Authority (State agency) claimed Federal Medicaid reimbursement for inpatient hospital services related to treating certain provider-preventable conditions (PPCs). For the period July 1, 2012, through December 31, 2013, we identified 463 claims totaling $18.3 million...

North Carolina Baptist Hospital (the Hospital), located in Winston Salem, North Carolina, complied with Medicare billing requirements for 209 of the 246 inpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 37 claims...

The Ohio Department of Medicaid (State agency) did not always use the correct Federal medical assistance percentages (FMAP) when processing Medicaid claim adjustments reported on the CMS-64. Of the 1,585,792 claim adjustments we reviewed, we determined that 1,204,718 adjustments (composed of 900,413...

From January 1, 2011, through December 31, 2012, the Ohio Department of Medicaid (State agency) made incorrect Medicaid electronic health record (EHR) incentive payments totaling $526,000 to 10 hospitals. Incorrect payments included both overpayments and underpayments, for a net overpayment of $524...