Department of Health & Human Services OIG

Not all of the District of Columbia marketplace's (District marketplace) internal controls were effective in ensuring that individuals were enrolled in qualified health plans (QHP) according to Federal requirements.

Nevada did not allocate costs for establishing a health insurance marketplace to its establishment grants in accordance with Federal requirements. As a result, Nevada misallocated $893,000 in costs to the establishment grants instead of the Medicaid program over 3 years.

Hennepin County Medical Center (the Hospital) complied with Medicare billing requirements for 134 of the 211 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 77 claims, resulting in overpayments of $537,000...

Not all of the Minnesota marketplace's internal controls were effective in ensuring that individuals were enrolled in qualified health plans (QHPs) according to Federal requirements.

Greenville Memorial Hospital (the Hospital), operating in South Carolina, complied with Medicare billing requirements for 257 of the 281 inpatient and outpatient claims that we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 24 claims...

The South Dakota Department of Social Services (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 $2 million ($1.2 million Federal...

HPM Foundation, Inc. (HPM), operating in San Juan, Puerto Rico, did not comply with all applicable Federal requirements and grant terms related to its Affordable Care Act-funded capital development grant. Specifically, HPM claimed unallowable construction consulting costs totaling $35,000. In...

Health Research, Inc., appropriately budgeted and claimed allowable Hurricane Sandy Disaster Relief Act funding. Accordingly, this report does not contain recommendations.

Medicare paid 10 of 143 selected inpatient claims for bone marrow and stem cell transplant procedures in accordance with Medicare requirements. However, 133 claims did not comply with those requirements. For 120 of these claims, the hospitals incorrectly billed Medicare Part A for beneficiary stays...

Promise Hospital of Ascension (The Hospital), in Gonzales, Louisiana, did not comply with Medicare requirements for billing Kwashiorkor on any of the 62 claims that we reviewed. The Hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no...