Department of Health & Human Services OIG

A chiropractic clinic based in Michigan (Michigan Chiropractor) did not comply with Medicare billing requirements for 100 chiropractic service line items that we sampled. Specifically, the medical records did not support the medical necessity for 92 of the 100 sampled chiropractic services. On the...

The Texas Health and Human Services Commission (State agency) did not always calculate supplemental payments made to the University of Texas (UT) health institutions in accordance with Federal and State requirements. Specifically, the supplemental payment calculations included overstated Medicare...

Although the Arizona Health Care Cost Containment System (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 and State requirements. Specifically, from October 1, 2011, through...

CMS established loan agreements with Consumer Operated and Oriented Plans (CO-OPs) to provide startup and solvency loan funding. CMS issued a memo to the CO-OPs in July 2015 allowing the CO-OPs to convert startup loans into surplus notes. A surplus note is a bondlike instrument issued to provide...

New York-Presbyterian Hospital (the Hospital) located in New York, New York, complied with Medicare billing requirements for 162 of the 285 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 123 claims for the...

Cornerstone Hospital of Austin (the Hospital), in Austin, Texas, did not comply with Medicare requirements for billing Kwashiorkor on any of the 54 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition. The 54 inpatient...

From 2011 through 2014, the Louisiana Department of Health made incorrect Herceptin payments to Medicaid providers, which resulted in overpayments of approximately $2.1 million (Federal share).

In Federal fiscal year 2014, the Texas Department of Health and Human Services Commission improperly charged Medicaid $55,000 for colocated warehouse costs included in the miscellaneous regional cost pool.

From July 2011 through June 2014, the New York Department of Health (State agency) improperly claimed approximately $300,000 in incorrect Federal Medicaid reimbursement for the drug Herceptin.

First Coast Service Options, Inc., a Medicare contractor, did not claim $740,000 of allowable Supplemental Executive Retirement Plan costs for fiscal years 2006 through 2009.