Department of Health & Human Services OIG

The California Department of Health Care Services (State agency) did not always comply with Federal Medicaid requirements for billing manufacturers for rebates for physician-administered drugs during three selected quarters between 2008 and 2010. Of $178.6 million in claims that were billed for...

For the period October 2007 through September 2014, we determined that the California Department of Health Care Services (State agency) did not correctly claim Medicaid expenditures for Indian Health Service facilities in accordance with Federal requirements.

Not all of the Connect for Health Colorado's (Colorado marketplace) internal controls were effective in ensuring that individuals were enrolled in qualified health plans (QHPs) according to Federal requirements. QHPs are private health insurance plans that each marketplace recognizes and certifies...

The New York State Department of Health (State agency) claimed Medicaid reimbursement for some Medicaid adult day health care (ADHC) services that did not comply with certain Federal and State requirements. Of the 100 claims in our random sample, the State agency properly claimed Medicaid...

Teaching & Mentoring Communities (TMC) claimed $635,000 in costs that were unallowable under applicable Federal rules and the terms of grants that it was awarded. This amount consisted of $617,000 in health insurance costs that TMC overcharged, $16,000 in unsupported consulting costs and $2,000 in...

Of the $27.6 billion in Federal Medicaid funds that the California Department of Health Care Services (State agency) obtained for fiscal year (FY) 2010, $20.3 million was not supported by net expenditures. Specifically, the State agency (1) refunded less to its FY 2010 Payment Management System (PMS...

For the period October 2007 through September 2014, we determined that the South Carolina Department of Health and Human Services (State agency) incorrectly claimed Affordable Care Act Medicaid expenditures totaling $59,149,483 as Indian Health Service expenditures; however, there is no monetary...

Nebraska Methodist Hospital (the Hospital) (operating in Omaha, Nebraska) complied with Medicare billing requirements for 119 of the 138 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 19 claims, resulting...

Englewood Hospital and Medical Center (the Hospital) (operating in New Jersey) claimed Medicare reimbursement for outpatient cardiac and pulmonary rehabilitation services that did not comply with Medicare reimbursement requirements. For 46 of the 100 claims in our random sample, the Hospital...

For the period October 2007 through September 2014, we determined that the Alaska Department of Health and Social Services (State agency) overstated the Federal share of Indian Health Service Medicaid expenditures on the CMS-64.9 by $1.4 million. These errors occurred because the State agency did...