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Abbreviation
HHSOIG
Agencies
Department of Health & Human Services
Federal Agency
Yes
Location

United States

What to Report to the OIG Hotline
The U.S. Department of Health and Human Services (HHS) Office of Inspector General's (OIG) mission is to protect the integrity of HHS programs as well as the health and welfare of program beneficiaries. In doing so, we rely on complaints by HHS employees, contractors, subcontractors, grantees and subgrantees (i.e. whistleblowers) who report fraud, waste, abuse or mismanagement in HHS programs. We also review and investigate reports of whistleblower retaliation. If you would like more information on what kinds of complaints our OIG investigates, please visit our website at https://oig.hhs.gov/fraud/report-fraud/before-you-submit.asp. There you will find a list of things you should know before submitting a complaint to the OIG. If you would like more information on the types of whistleblowers protected by the OIG, please visit our whistleblower protection page at https://oig.hhs.gov/fraud/report-fraud/whistleblower.asp. If you are a whistleblower and wish to report fraud, waste, abuse or mismanagement in HHS programs, or you wish to report whistleblower retaliation, please visit our Hotline at https://oig.hhs.gov/fraud/report-fraud/index.asp.
What Not to Report to the OIG Hotline
  • Issues about Medicare policy, coverage, billing claims or appeals
  • Lost or stolen Medicare card
  • Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference
  • Allegations by employees or applicants concerning prohibited personnel practices; or Hatch Act violations
  • Appeals of administrative decisions made by HHS agencies, grantees or contractors, including Medicare payment decisions and contract or grant awards
  • Appeals of judicial decisions by federal or state courts involving HHS programs
  • Complaints of failure to safeguard medical information, i.e. HIPAA violations
  • Customer service complaints involving HHS employees, grantees or contractors
  • Allegations of identity theft unrelated to HHS programs
  • Disability fraud
  • SNAP/Food Stamp Fraud
  • Self-Disclosures

High-Price Drugs Are Increasing Federal Payments for Medicare Part D Catastrophic Coverage

2017
OEI-02-16-00270
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Members of Congress and others have raised concerns about the high prices of certain drugs and the impact these high prices have on Medicare beneficiaries and the health care system. An important part of the Medicare Part D benefit is catastrophic coverage, which beneficiaries enter when their out...

Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy

2017
OEI-06-16-00360
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Inpatient rehabilitation (rehab) hospitals are freestanding facilities that specialize in providing intensive rehab therapy to patients recovering from illness, injury, or surgery. This intensive therapy requires endurance that some patients receiving post-acute care do not have, potentially causing...

Early Implementation Review: CMS's Management of the Quality Payment Program

2017
OEI-12-16-00400
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted clinician payment reforms designed to put increased focus on the quality and value of care. These reforms, known as the Quality Payment Program (QPP), are a significant shift in how Medicare calculates compensation for...

Oregon State Medicaid Fraud Control Unit: 2016 Onsite Review

2017
OEI-09-16-00200
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

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 and prepares public reports based...

Medicare Market Shares of Mail Order Diabetes Test Strips From April to June 2016

2017
OEI-04-16-00470
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

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 (DMEPOS). Under this program, suppliers compete to become Medicare contract suppliers for selected...

State Use of Express Lane Eligibility for Medicaid and CHIP Enrollment

2017
OEI-06-15-00410
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage for certain low-income children, yet millions of eligible children are still uninsured. To increase enrollment of eligible children, Congress authorized States to adopt the Express Lane Eligibility (ELE)...

Indian Health Service Hospitals: Longstanding Challenges Warrant Focused Attention to Support Quality Care

2017
OEI-06-14-00011
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

We conducted this study and its companion, Indian Health Service Hospitals: More Monitoring Needed to Ensure Quality Care (OEI-06-14-00010), in response to concerns about the care provided in IHS hospitals. Reports of inadequate health care services for American Indians and Alaska Natives (AI/ANs)...

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline Data

2016
OEI-09-16-00040
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Clinical diagnostic laboratory (lab) tests provide information integral to preventing, diagnosing, and treating disease in millions of Medicare beneficiaries every year. The Protecting Access to Medicare Act of 2014 (PAMA) requires reform of Medicare's payment system for lab tests-the first such...

Maryland State Medicaid Fraud Control Unit: 2016 Onsite Review

2016
OEI-07-16-00140
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

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 onsite reviews of all Units and prepares public reports...

HHS Has Made Progress in Properly Classifying Documents; However, New Issues Should be Addressed

2016
OEI-07-16-00080
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Classification is an important tool that allows the Federal government to protect information that might damage national security; however, over-classification may pose risks to national security, too. Over-classification may prevent Federal agencies from sharing information internally and with...

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