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What's New

See also: Archive

July 2024

07-12-2024
Updated: Corporate Integrity Agreements
07-11-2024
Updated: Corporate Integrity Agreements
07-10-2024
LEIE Database Updated with June 2024 Exclusions and Reinstatements
07-08-2024
NEW HHS-OIG Impact Brief: Medicare Advantage Fraud
Updated FAQ: General Questions Regarding Certain Fraud and Abuse Authorities
07-05-2024
Updated: Fraud Self-Disclosures
Updated: Grant and Contractor Fraud Self-Disclosures
07-02-2024
2023 Performance Data for the Senior Medicare Patrol Projects OEI-02-24-00260
07-01-2024
Updated: CMP and Affirmative Exclusions

June 2024

06-28-2024
Part D Plans Generally Include Drugs Commonly Used by Dual-Eligible Enrollees: 2024 OEI-05-24-00210
Review of the Department of Health and Human Services’ Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2023 A-18-23-11200
06-27-2024
2024 Nationwide Health Care Fraud Enforcement Action
The National Institutes of Health Has Made Progress But Could Further Improve Its Closeout Process for Grants and Similar Awards A-04-23-08097
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Independent Health Association, Inc. (Contract H3362) Submitted to CMS A-07-19-01194
06-26-2024
Many States Lack Information To Monitor Maltreatment in Residential Facilities for Children in Foster Care OEI-07-22-00530
06-25-2024
North Carolina Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases A-06-23-04004
06-20-2024
NIH Did Not Close Contracts in Accordance With Federal Requirements, Resulting in the Increased Risk of Fraud, Waste, and Abuse A-04-23-03585
Advisory Opinion 24-04 Favorable opinion regarding: (i) a limited-time program to refund, waive, or delay requiring receipt of payment for a drug in the event of an insurance reimbursement denial or delay; and (ii) certain discounts to the cost of the drug.
06-18-2024
Updated: Corporate Integrity Agreements
06-17-2024
Updated: Work Plan
Advisory Opinion 24-03 Favorable opinion regarding assistance, including travel, lodging, meals, and associated expenses, provided by a pharmaceutical manufacturer to qualifying patients receiving its gene therapy product and their caregivers.
06-13-2024
The Food and Drug Administration's Inspection and Recall Process Should Be Improved To Ensure the Safety of the Infant Formula Supply A-01-22-01502
CMS Could Strengthen Program Safeguards To Prevent and Detect Improper Medicare Payments for Short Inpatient Stays A-09-21-03022
06-11-2024
Updated: Corporate Integrity Agreements
06-10-2024
LEIE Database Updated with May 2024 Exclusions and Reinstatements
Washington Medicaid Fraud Control Unit: 2023 Inspection OEI-09-23-00230
06-07-2024
Updated: Fraud Self-Disclosures
06-04-2024
Updated: Corporate Integrity Agreements
06-03-2024
Spring 2024 Semiannual Report to Congress
HHS-OIG Reports Nearly $3 Billion in Expected Recoveries in Newly Streamlined Semiannual Report
OpEd: Pandemic lessons must spur federal action to protect nursing home residents

May 2024

05-30-2024
Fall 2024 OIG Health Care Fraud and Abuse Legal Internship
05-29-2024
Medicare Remains Vulnerable to Fraud, Waste, and Abuse Related to Off-the-Shelf Orthotic Braces, Which May Result in Improper Payments and Impact the Health of Enrollees A-09-21-03019
05-28-2024
Plans and Enrollment Often Fell Short for Underrepresented Groups in a Sample of NIH-Funded Clinical Trials OEI-01-21-00320
05-23-2024
Medicaid Managed Care: States Do Not Consistently Define or Validate Paid Amount Data for Drug Claims OEI-03-20-00560
05-22-2024
Wanted Fugitive: Dr. Yogeshwar Singh "Garry" Gill
Selected CDC Racial and Ethnic Approaches to Community Health Program Recipients Generally Complied With Federal Requirements But Did Not Meet All Targets and Charged Some Unallowable Costs A-02-22-02001
05-21-2024
California Improperly Claimed $52.7 Million in Federal Medicaid Reimbursement for Capitation Payments Made on Behalf of Noncitizens With Unsatisfactory Immigration Status A-09-22-02004
05-20-2024
Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for the Fiscal Year 2023 A-17-24-52000
Updated: Corporate Integrity Agreements
Office of Counsel Job Opening: Special Policy Advisor/Reviewing Official
05-16-2024
Employee Profile: Deputy Regional Inspector General Meridith Seife: Creative Problem Solving to Make Meaningful, Positive Change in People's Lives
Updated: Corporate Integrity Agreements
05-15-2024
Updated: Work Plan
Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for Some Cases Identified by the State’s Program Integrity Section A-07-19-02816
05-14-2024
New York Medical College Claimed Unallowable Grant Costs and Did Not Meet Certain Financial Conflict of Interest Requirements A-04-20-03583
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2023 OEI-03-24-00060
05-13-2024
New Mexico Should Refund Almost $120 Million to the Federal Government for Medicaid Nursing Facility Level-of-Care Managed Care Capitated Payments A-06-20-09001
Updated: CMP and Affirmative Exclusions
05-10-2024
LEIE Database Updated with April 2024 Exclusions and Reinstatements
Potential Vulnerabilities in CMS Oversight of Medicare Add-on Payments for COVID-19 Tests Show That Oversight of Incentive Payments Could Be Improved A-09-22-03015
State Agencies Could Be Obtaining Hundreds of Millions in Additional Medicaid Rebates Associated With Physician-Administered Drugs A-07-23-06111
05-09-2024
California Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements A-09-24-02001
Updated: Corporate Integrity Agreements
05-08-2024
Survey on the Role of Patient Selection Criteria in Ensuring Equitable Access to Kidney Transplantation
Updated: Fraud Self-Disclosures
Updated: Corporate Integrity Agreements
05-07-2024
Office of Inspector General’s Partnership With the State of Rhode Island, Office of the Auditor General: Medicaid Capitation Paid for Members Residing in Other States A-01-23-00001
05-02-2024
Medicaid Enrollees May Not Be Screened for Intimate Partner Violence Because of Challenges Reported by Primary Care Clinicians OEI-03-21-00310
05-01-2024
Updated: FY 2024 Q1-Q2 False Claims Act Settlements on the Risk Spectrum

April 2024

04-30-2024
The Office of Intergovernmental and External Affairs’ Purchase Card Program Did Not Comply With Federal and HHS Requirements A-03-22-00500
04-29-2024
Florida Ensured That Nursing Homes Complied with Federal Background Check Requirements A-04-23-08100
04-25-2024
West Virginia Lacked Effective Oversight of Its Opioid Response Grants A-06-22-01005
04-22-2024
SENTENCED: Lilit Galstyan, Former HHS-OIG Fugitive
04-18-2024
28th Annual Compliance Institute - HHS-OIG Enforcement and Compliance Update
04-17-2024
Employee Profile: Dan Hoy
04-16-2024
The Testimony of Inspector General Christi A. Grimm: Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid
04-15-2024
Updated: Work Plan
Updated: Corporate Integrity Agreements
04-11-2024
Ohio Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements A-05-23-00019
Advisory Opinion 24-02 Favorable opinion regarding patient assistance funds operated by a nonprofit, tax exempt charitable organization.
04-10-2024
LEIE Database Updated with March 2024 Exclusions and Reinstatements
Updated: Corporate Integrity Agreements
04-05-2024
CMS Could Improve Its Procedures for Setting Medicare Clinical Diagnostic Laboratory Test Rates Under the Clinical Laboratory Fee Schedule for Future Public Health Emergencies A-01-21-00506
Missouri May Not Have Used All CARES Act Funds for the Older Americans Act Nutrition Services Program in Accordance With Federal and State Requirements A-07-22-04130
Alabama MMIS and E&E System Security Controls Were Adequate, but Some Improvements Are Needed A-18-22-09010
04-04-2024
New York Generally Identified and Corrected Duplicate Children’s Health Insurance Plan Payments Made to Managed Care Organizations A-02-23-01017
Alabama Claimed Federal Medicaid Reimbursement for Millions of Dollars in Targeted Case Management Services That Did Not Comply With Federal and State Requirements A-07-22-03253
Updated: CIA Reportable Events
Updated: CMP and Affirmative Exclusions
Updated: Fraud Self-Disclosures
Updated: Grant and Contractor Fraud Self-Disclosures
04-03-2024
Nursing Home Residents With Endangering Behaviors and Mental Health Disorders May Be Vulnerable to Facility-Initiated Discharges OEI-01-18-00252
Concerns Remain About Safeguards To Protect Residents During Facility-Initiated Discharges From Nursing Homes OEI-01-18-00251
ACF Has Enhanced Some Cybersecurity Controls Over the Unaccompanied Children Portal and Data But Improvements Are Needed A-18-22-03200
A Lack of Behavioral Health Providers in Medicare and Medicaid Impedes Enrollees’ Access to Care OEI-02-22-00050
04-02-2024
Administration for Children and Families Data Hosted in Certain Cloud Information Systems May Be at a High Risk of Compromise A-18-22-08020
Fiscal Year 2018 and 2019 Biomedical Advanced Research and Development Authority Appropriations May Not Have Been Used for Their Intended Purpose in Accordance With Federal Requirements A-03-20-03002
04-01-2024
New Jersey Significantly Improved Its Oversight of Medicaid Adult Partial Care Services Except for Those Provided Using Telehealth During the COVID-19 Public Health Emergency A-02-22-01007
IHS Did Not Coordinate Supply Service Center Operations Before and During the COVID-19 Pandemic and Should Consider Upgrading Supply Centers’ Inventory Management Systems and Implementing Policies and Procedures To Enhance Coordination and Alignment  A-07-22-04131

March 2024

03-29-2024
New Jersey Complied With Federal Regulations When Implementing Programs Under SAMHSA’s Opioid Response Grants, But Did Not Meet Its Program Services Goals A-02-22-02002
03-28-2024
CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements A-02-22-01016
03-27-2024
The Thailand Ministry of Public Health Managed PEPFAR Funds According to Federal Regulations but Internal Controls Could Be Improved A-04-21-01021
Delaware Made Capitation Payments to Medicaid Managed Care Organizations After Enrollees' Deaths A-03-22-00205
03-26-2024
HHS-OIG Cybersecurity Toolkit: Cybersecurity Considerations For HHS's Rapid Rollout of Information Systems
03-25-2024
Updated: CMP and Affirmative Exclusions
03-21-2024
New Video: HHS-OIG's Perspective on Managed Care
03-19-2024
Utah MMIS and E&E System Had Adequate Security Controls In Place, but Improvements Are Needed A-18-21-09001
South Carolina MMIS and E&E System Security Controls Were Adequate, but Some Improvements Are Needed A-18-22-09005
03-18-2024
NEW HHS-OIG Impact Brief: Medicare Advantage Prior Authorization
03-15-2024
Updated: Work Plan
03-14-2024
Medicaid Fraud Control Units Fiscal Year 2023 Annual Report
03-13-2024
IG Grimm Named Among Top Women Leaders in Health Care
Kansas’s Medicaid Estate Recovery Program Was Cost Effective, but Kansas Did Not Always Follow Its Procedures, Which Could Have Resulted in Reduced Recoveries A-07-22-03254
Pennsylvania Improperly Claimed $551 Million in Medicaid Funds for Its School-Based Program A-02-21-01011
03-12-2024
Issue Brief: Insights from OIG’s Work on the Office of Refugee Resettlement’s Efforts to Care for Unaccompanied Children OEI-09-23-00440
03-11-2024
FY 2025 Congressional Budget Justification
Updated: CMP and Affirmative Exclusions
03-08-2024
LEIE Database Updated with February 2024 Exclusions and Reinstatements
03-07-2024
HRSA Made Some Potential Overpayments to Providers Under the Phase 2 General Distribution of the Provider Relief Fund Program A-09-22-06001
Updated: Fraud Self-Disclosures
03-06-2024
Consumer Alert: Urinary Catheter Scams
Data Snapshot: Biosimilar Cost and Use Trends in Medicare Part B OEI-05-22-00141

February 2024

02-29-2024
Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes OEI-02-20-00492
02-26-2024
Advisory Opinion 24-01 Favorable opinion regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby an insurance company would contract with a preferred hospital organization to provide discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay.
02-22-2024
New: Single Audits - Information and Oversight Activities
02-20-2024
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That MediGold (Contract H3668) Submitted to CMS A-07-20-01198
Findings of Whistleblower Retaliation by Indian Health Service Contractor Management
Updated: Connecticut State False Claims Act Review Letter
02-16-2024
Report to Congress on the Reported Impact of Discarded-Drug Refunds on Biosimilar Biological Products A-06-23-04003
02-15-2024
Gaps in Sponsor Screening and Followup Raise Safety Concerns for Unaccompanied Children OEI-07-21-00250
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2023 OEI-03-24-00050
Updated: Work Plan
02-14-2024
Medicare Generally Paid for Evaluation and Management Services Provided via Telehealth During the First 9 Months of the COVID-19 Public Health Emergency That Met Medicare Requirements A-01-21-00501
Updated: Corporate Integrity Agreements
02-08-2024
NIH Generally Implemented System Controls Over the Sequence Read Archive But Some Improvements Needed A-18-22-03300
LEIE Database Updated with January 2024 Exclusions and Reinstatements
Updated: Fraud Self-Disclosures
02-06-2024
Colorado Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control A-07-22-07009
Job Opening: ACRB Deputy Branch Chief
02-02-2024
Updated: Corporate Integrity Agreements

January 2024

01-29-2024
Updated: CMP and Affirmative Exclusions
01-26-2024
Updated: Fraud Risk Indicator
01-22-2024
Updated: CMP and Affirmative Exclusions
01-19-2024
HHS-OIG Issues Notice of Exclusion to Founder and CEO of Theranos, Inc.
01-18-2024
Updated: Corporate Integrity Agreements
01-16-2024
Two Tribes in Oklahoma and Their Health Programs Did Not Meet All Federal and Tribal Requirements for Background Investigations on Individuals in Contact With Indian Children A-01-20-01505
Updated: Work Plan
01-12-2024
CDC Has Improved the Nursing Homes Reporting Process for COVID-19 Data in NHSN, but Challenges Remain OEI-06-22-00030
Updated: Corporate Integrity Agreements
Updated: Fraud Self-Disclosures
Updated: Grant and Contractor Fraud Self-Disclosures
01-11-2024
Independent Attestation Review: Substance Abuse and Mental Health Services Administration Fiscal Year 2023 Detailed Accounting Report and Budget Formulation Compliance Report for National Drug Control Activities and Accompanying Required Assertions A-03-24-00352
Independent Attestation Review: Indian Health Service Fiscal Year 2023 Detailed Accounting Report and Budget Formulation Compliance Report for National Drug Control Activities, and Accompanying Required Assertions A-03-24-00351
Letter to Office of Management and Budget Director to Meet Requirements of Government Charge Card Abuse Prevention Act of 2012 Regarding Agency Progress Implementing Recommendations on Charge-Card-Related Findings A-04-24-02041
01-10-2024
LEIE Database Updated with December 2023 Exclusions and Reinstatements
Job Opening: ACRB Deputy Branch Chief
01-09-2024
Oklahoma Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control A-06-22-09007
Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-23-00637
Cahaba Safeguard Administrators, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2020 A-07-23-00631
Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-23-00635
Cahaba Government Benefits Administrators, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-23-00634
Cahaba Government Benefits Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-23-00636
01-05-2024
Cahaba Government Benefits Administrators, LLC, Properly Updated the Medicare Segment Pension Assets and Overstated Medicare's Share of the Medicare Segment Excess Pension Liabilities as of December 31, 2018 A-07-22-00627
01-03-2024
Advisory Opinion 23-12 Favorable opinion regarding a one-time, voluntary redemption offer to physician partners reaching age 67 to have their partnership units repurchased by a partnership over a 2-year period, contingent upon the physician partners’ agreement to retire from the practice of medicine.
Advisory Opinion 23-13 Favorable opinion regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby an insurance company would contract with a preferred hospital organization to provide discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay.
Advisory Opinion 23-14 Favorable opinion regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby an insurance company would contract with a preferred hospital organization to provide discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay.
Advisory Opinion 23-15 Favorable opinion regarding a physician consulting company’s proposal to offer physician practices that are current customers of the company certain gift cards for referring potential new physician practice customers.

Archive