Federal Reports

Tennessee did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Of the 120 capitation payments in our random sample selected from payments for beneficiaries whose dates of death (DODs) preceded the payment dates, Tennessee recovered 43 prior to the start of our audit, and 13 were not recoverable. For the remaining 64 payments, Tennessee made unallowable payments totaling $39,909 ($27,357 Federal share). During our audit, Tennessee adjusted 35 of the 64 payments totaling $23,614. On the basis of our sample results, we estimated that Tennessee made overpayments to managed care organizations (MCOs) totaling $2.7 million ($1.8 million Federal share) during our audit period. These unallowable payments amount to less than 1 percent of the $3.8 billion that the Tennessee paid to MCOs from July 1, 2009, through March 4, 2016.

Before the start of our audit, the Nebraska did not invoice rebate-eligible physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations (MCOs). Specifically, the State agency did not invoice manufacturers for rebates totaling $1.9 million ($1.1 million Federal share). These errors occurred because Nebraska did not have established policies and procedures in place to ensure that it accurately invoiced manufacturers to collect rebates for physician-administered drugs dispensed to enrollees of MCOs.

The Patient Protection and Affordable Care Act of 2010 established the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV program) in 2010, and it was to be collaboratively implemented by HHS's Health Resources and Services Administration and the Administration for Children and Families.

New York did not always follow Federal requirements for allocating and claiming contract costs to its grants for establishing New York's marketplace customer service center. Specifically, New York may have misallocated costs totaling nearly $19.6 million and claimed unallowable profit fees and other costs totaling nearly $3.8 million.

Prior Office of Inspector General (OIG) reviews focused on U.S. Food and Drug Administration (FDA) oversight of food recalls. Food recalls are the most effective means of protecting public health when a widely consumed food product is either defective or potentially harmful. At the time of those OIG reviews, FDA did not have statutory authority to require food manufacturers to initiate recalls of most foods.