Department of Health & Human Services OIG

We reviewed the Centers for Medicare & Medicaid Services' (CMS) administration of the Pioneer Accountable Care Organization (ACO) Payment Model (Pioneer Model).

The Utah Department of Health, Division of Medicaid and Health Financing (State agency), did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. The State agency did not invoice manufacturers for rebates associated with $6...

Some contract supplies in Round 2 of the Durable Medical Equipment Competitive Bidding Program had not met all of the competitive bidding licensure requirements. Specifically, of the 146 suppliers covered in our audit, 69 suppliers met licensure requirements. However, 63 suppliers did not meet...

The New Jersey Office of the State Comptroller, Medicaid Fraud Division, did not always suspend Medicaid payments to providers with credible allegations of fraud in accordance with the Affordable Care Act. Of the 49 providers with credible allegations of fraud that we reviewed, the Medicaid Fraud...

The Connecticut Department of Social Services (State agency) did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents...

From October 1, 2009, through September 30, 2012, the Washington State Health Care Authority (State agency) claimed $117,000 in unallowable Federal Medicaid reimbursement for dental services. The unallowable payments consisted of (1) duplicate payments, (2) payments for services that were provided...

The payments that Medicare contractors made to providers in Jurisdiction E (American Samoa, California, Guam, Hawaii, Nevada, and Northern Mariana Islands) and Jurisdiction F (Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming) for hospital outpatient...

Precision Health, Inc., (Precision), (located in Staten Island, New York) complied with certain Medicare Part B requirements for 88 of the 117 claims that we sampled. However, the remaining 29 claims did not comply with certain Medicare requirements. On the basis of our sample results, we estimated...

Huntsville Hospital (the Hospital) (operating in Huntsville, Alabama) complied with Medicare billing requirements for 178 of the 277 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 99 claims, resulting in...

The Centers for Disease Control and Prevention (CDC) did not award President's Emergency Plan for AIDS Relief (PEPFAR) funds for fiscal year 2013 in compliance with Department of Health and Human Services (HHS) and internal policies. For all 30 Funding Opportunity Announcements (FOAs) in our...