Federal Reports

Medicare Administrative Contractors (MACs) are responsible for reviewing Part B outpatient drug claims to ensure that Medicare pays for drugs that meet the criteria for coverage. Each MAC determines whether a particular use for a given drug, such as a use not approved by the Food and Drug Administration, is "medically accepted" and therefore, covered in its jurisdiction. If MACs do not have appropriate methods to determine drug coverage, Medicare and its beneficiaries may pay for drug uses that are not medically accepted. Further, beneficiaries' access to drugs may vary based on the coverage criteria set in their jurisdictions. This study reviewed the methods MACs used to make coverage determinations for Part B drugs, as well as their methods for ensuring that claims were paid according to these coverage determinations.

This is our final report on OIG’s audit of CS China operations. We conducted this audit as part of our FY 2015 audit plan. Our audit objectives were to (1) assess the roles and responsibilities of Commerce staff components in China and the adequacy of cost-sharing agreements; (2) assess the adequacy of controls over personal property inventory at CS China’s six offices; and (3) review the responsiveness of USFCS staff with respect to client service delivery.

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 onsite reviews of all Units and prepares public reports based on these reviews. The reviews assess the Units' adherence to the 12 MFCU performance standards and compliance with applicable Federal statutes and regulations.