Department of Health & Human Services OIG

This report fulfills for 2017 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA) for 2017. The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible...

In 2016, the Federal Government and States spent $574 billion on Medicaid, serving more than 74 million enrolled individuals. Complete, accurate, and timely Medicaid data are vital for the effective administration and oversight of the Medicaid program by States and the Federal Government...

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from ACL to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. OIG has collected these performance...

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires CMS to phase in a Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies. In July 2013, the program was expanded to include a National Mail-Order Program for diabetes testing...

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Competitive Bidding Program for durable medical equipment (DME). The program replaces a fee schedule with a competitive bidding process to set Medicare reimbursement amounts in certain areas. In a 2014 letter...

The Office of Inspector General (OIG) administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units...

Biosafety and biosecurity incidents at laboratories involving select agents and toxins have raised concerns regarding how CDC's Division of Select Agents and Toxins (DSAT) oversees entities that handle select agents and toxins, as well as the potential impact to public health and safety. For...

Accurate data are fundamental to CMS's quality-based payment programs, including Hospital Inpatient Quality Reporting (IQR). This evaluation focuses on CMS's efforts to ensure the integrity of IQR data. IQR data are used to adjust payments on the basis of quality measures, so inaccurate data poses...

Ensuring that only eligible applicants can enroll in qualified health plans (QHPs) and insurance affordability programs depends on the integrity of the enrollment process. A key part of that process involves resolving inconsistencies between self-attested information submitted by applicants and data...

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires CMS to phase in a Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies. Initially, under this program, suppliers competed to become Medicare contract suppliers for diabetes...