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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

Medicaid: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure

2016
OEI-04-11-00590
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

States can prevent inappropriate payments, protect beneficiaries, and reduce time-consuming and expensive "pay and chase" activities by ensuring that providers that intend to engage in fraudulent or abusive activities are not allowed to enroll in Medicaid. For States to identify potentially...

Medicaid Fraud Control Units Fiscal Year 2016 Annual Report

2016
OEI-09-17-00210
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCUs or Units). This MFCU Fiscal Year (FY) 2016 Annual Report highlights statistical achievements from the investigations and prosecutions the 50 MFCUs conducted...

Medicare Benefit Integrity Contractors' Activities in 2012 and 2013: A Data Compendium

2016
OEI-03-13-00620
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

This report provides a visual representation of data on the workload activities of Medicare benefit integrity contractors in calendar years 2012 and 2013. The report allows for a quick comparison of workload statistics across the 2 years, across contractors, and across Medicare programs and provides...

Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results

2016
OEI-03-13-00050
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

To bill for services they provide to beneficiaries, providers must enroll in Medicare and periodically revalidate this enrollment. Effective enrollment screening is an important tool in preventing Medicare fraud. The Centers for Medicare & Medicaid Services (CMS) has sought to enhance the enrollment...

Oklahoma State Medicaid Fraud Control Unit: 2014 Onsite Review

2016
OEI-06-14-00630
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

The Office of Inspector General (OIG) oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12...

Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care

2016
OEI-02-10-00491
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Recent investigations by the Office of Inspector General have shown a number of instances in which hospices inappropriately billed Medicare for hospice general inpatient care (GIP). Misuse of GIP includes care being billed but not provided and beneficiaries receiving care they do not need. Such...

HealthCare.gov: Case Study of CMS Management of the Federal Marketplace

2016
OEI-06-14-00350
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

As required by the Affordable Care Act (ACA), HealthCare.gov is the Federal website that facilitates purchase of private health insurance for consumers who reside in States that did not establish health insurance marketplaces. At its launch on October 1, 2013, and for some time after, HealthCare.gov...

California State Medicaid Fraud Control Unit: 2015 Onsite Review

2016
OEI-09-15-00070
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

OIG oversees all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit...

Delaware State Medicaid Fraud Control Unit: 2015 Onsite Review

2016
OEI-07-15-00240
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...

National Background Check Program for Long Term Care Employees: Interim Report

2016
OEI-07-10-00420
Inspection / Evaluation
Department of Health & Human Services OIG
Department of Health & Human Services

Long-term-care employees provide essential care to patients in settings such as nursing facilities, home health agencies, and hospices. Ensuring that these employees have undergone a minimum level of screening helps protect the safety of beneficiaries in these settings. The Patient Protection and...

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