Department of Health & Human Services OIG

Federal law requires that each Medicare administrative contractor (MAC) have its information security program evaluated annually by an independent entity, and these evaluations must address the eight major requirements enumerated in the Federal Information Security Management Act of 2002 (FISMA). To...

A Florida physical therapy practice (the Therapy Practice), located in Boca Raton, Florida, properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days that we sampled. However, the Therapy Practice improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days...

TrailBlazer Health Enterprises, LLC, a subsidiary of Blue Cross Blue Shield South Carolina, claimed unallowable pension costs of $341,000 for Medicare reimbursement for fiscal years 2003 and 2004.

Palmetto Government Benefits Administrator, LLC, a subsidiary of Blue Cross Blue Shield South Carolina, claimed unallowable pension costs of $132,000 for Medicare reimbursement for fiscal years 2003 and 2004.

Palmetto Government Benefits Administrator, LLC, understated its Medicare segment pension assets by $2.2 million and TrailBlazer Health Enterprises, LLC, understated its Medicare segment pension assets by $180,000 as of January 1, 2005. Both Palmetto and TrailBlazer were subsidiaries of Blue Cross...

Tufts Medical Center (Tufts) (operating in Boston, Massachusetts) complied with Medicare billing requirements for 4 of the 18 inpatient and outpatient claims we reviewed. However, Tufts did not fully comply with Medicare billing requirements for the remaining 14 claims, resulting in overpayments of...

The objective of this review was to determine potential Medicaid program savings if the Oregon Health Authority, Division of Medical Assistance Programs (State agency), had required its Medicaid coordinated-care organization (CCO) plans to meet medical loss ratio (MLR) standards for its non...

The National Institute of Environmental Health Sciences (the Institute) generally administered its Superfund appropriations during fiscal year (FY) 2014 in accordance with applicable Federal requirements. However, it did not always obligate Superfund appropriations in accordance with applicable...

DePaul Health Center (the Hospital) (operating in Bridgeton, Missouri) complied with Medicare billing requirements for 190 of the 204 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 14 claims (all of which...

Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 91...