What's New

December 2021

12-30-2021

• Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than at Wholly Owned Settings OEI-05-19-00380

12-23-2021

• Arkansas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-01003

12-21-2021

• Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern A-09-20-03027

12-20-2021

• Medicare Hospital Provider Compliance Audit: St. Joseph's Hospital Health Center A-02-20-01004
• The Food and Drug Administration Needs To Improve Its Contract Closeout Processes To Identify Contracts Eligible for Closeout and Close Contracts Timely A-03-20-03004

12-17-2021

• Updated: Corporate Integrity Agreements

12-16-2021

• Many Medicare Beneficiaries Are Not Receiving Medication to Treat Their Opioid Use Disorder
• Advisory Opinion 21-20 (Regarding Requestor's proposal to create an online platform for: (i) users to search for and contact home-based health care providers, where providers listed on the website wou

12-15-2021

• Updated: Work Plan

12-14-2021

• Updated Corporate Integrity Agreements FAQ: Should Reportable Events also be disclosed to the OIG's Self-Disclosure Protocol?

12-10-2021

• Medicare Could Have Saved Approximately $993 Million in 2017 and 2018 if It Had Implemented an Inpatient Rehabilitation Facility Transfer Payment Policy for Early Discharges to Home Health Agencies A-

12-09-2021

• LEIE Database Updated with November 2021 Exclusions and Reinstatements
• Updated: Corporate Integrity Agreements
• Updated: CMP and Affirmative Exclusions and Health Care Fraud Self-Disclosures

12-08-2021

• Video: HHS-OIG 2021 Year in Review

12-07-2021

• Updated: Corporate Integrity Agreements

12-06-2021

• New COVID-19 Enforcement Actions
• Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation Sessions A-09-21-03002
• Advisory Opinion 21-19 (Regarding Requestor's provision of free eye drops that mitigate side effects for patients using one of its products.)

12-03-2021

• Kentucky Made Almost $2 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Medicaid ID Numbers A-04-20-07094

12-02-2021

• 2021 Fall Semiannual Report to Congress
• Taxpayers Could Save Nearly $4 Billion Dollars as a Result of HHS-OIG Work in FY 2021
• Updated: Corporate Integrity Agreements
• New COVID-19 Work Plan Item

November 2021

11-24-2021

• CMS Should Strengthen Its Prescription Drug Event Guidance To Clarify Reporting of Sponsor Margin for Medicare Part D Bids A-03-17-00001

11-23-2021

• The Office of Intergovernmental and External Affairs Needs To Improve Internal Controls Over Its Travel Card Program A-03-19-00501

11-22-2021

• Facility-Initiated Discharges in Nursing Homes Require Further Attention OEI-01-18-00250
• New COVID-19 Enforcement Action
• Advisory Opinion 21-18 (Regarding a proposed joint venture for the provision of therapy services.)

11-19-2021

• Updated: Work Plan
• Advisory Opinion 21-17 (Regarding the proposed subsidization of beneficiary cost-sharing obligations for Medicare-covered services provided as part of a clinical trial.)

11-18-2021

• Missouri Properly Converted Provisionally Enrolled Medicaid Providers to Permanent Providers A-07-21-03248
• Medicare Improperly Paid Suppliers an Estimated $117 Million Over 4 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Hospice Beneficiaries A-09-20-03026

11-16-2021

• 2021 Top Management and Performance Challenges Facing HHS
• Characteristics of Separated Children in ORR's Care: June 27, 2018–November 15, 2020 OEI-BL-20-00680
• Advisory Opinion 21-16 (Regarding a pharmaceutical manufacturer's arrangement to provide up to a specified number of trial units of a long-acting antipsychotic drug to certain hospitals for inpatient
• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2021 OEI-03-22-00060

11-10-2021

• New COVID-19 Enforcement Action
• Updated: Corporate Integrity Agreements
• Advisory Opinion 21-15 (Regarding a pain management company's proposal to retain net profits from services provided by an employed certified registered nurse anesthetist pursuant to a reassignment of

11-09-2021

• Updated: Health Care Fraud Self-Disclosures
• LEIE Database Updated with October 2021 Exclusions and Reinstatements

11-08-2021

• The District of Columbia's Monitoring Did Not Ensure Child Care Provider Compliance With Criminal Background Check Requirements at 7 of 30 Providers Reviewed A-03-20-00252
• Updated: Health Care Fraud Self-Disclosure Protocol
• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UPMC Health Plan, Inc. (Contract H3907) Submitted to CMS A-07-19-01188
• Michigan Did Not Report Calendar Year 2019 Medicaid Third-Party Liability Cost Avoidance Data to the Centers for Medicare & Medicaid Services A-05-20-00058

11-04-2021

• Two Critical HHS Systems Were Deployed Without Authorizations to Operate
• Updated: CMP and Affirmative Exclusions and Updated Stipulated Penalties and Exclusion for Material Breach
• New COVID-19 Enforcement Action

11-03-2021

• Updated: Corporate Integrity Agreements

11-02-2021

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health Care of Missouri, Inc. (Contract H2663) Submitted to CMS A-07-17-01173

October 2021

10-28-2021

• Office of Inspector General's Partnership With the Commonwealth of Massachusetts Office of the State Auditor: Office of Medicaid (MassHealth) - Payments for Hospice-Related Services for Dual-Eligible

10-27-2021

• 2021 Top Unimplemented Recommendations: Solutions To Reduce Fraud, Waste, and Abuse in HHS Programs

10-26-2021

• Updated: Corporate Integrity Agreements

10-25-2021

• The National Institutes of Health Administered Superfund Appropriations During Fiscal Year 2020 in Accordance With Federal Requirements A-04-21-04081
• Video: HHS-OIG is Working for You

10-21-2021

• Tennessee Medicaid Claimed Hundreds of Millions of Federal Funds for Certified Public Expenditures That Were Not in Compliance With Federal Requirements A-04-19-04070
• Updated: Fraud Risk Indicator

10-20-2021

• More Than One-Third of Medicaid-Enrolled Children in Five States Did Not Receive Required Blood Lead Screening Tests OEI-07-18-00371
• Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship OEI-02-20-00521
• Annual Inflation Updates to the Annual Cap on Patient Engagement Tools and Supports Under 42 CFR § 1001.952(hh)

10-19-2021

• Updated: Work Plan
• New COVID-19 Work Plan Item

10-15-2021

• A Look at Drug Spending

10-14-2021

• Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic A-06-20-04007

10-13-2021

• U.S. Department of Health and Human Services Met the Requirements of the Digital Accountability and Transparency Act of 2014, With Areas That Require Improvement A-17-21-54000

10-08-2021

• Minnesota Medicaid Managed Care Entities Used a Majority of Medicaid Funds Received for Medical Expenses and Quality Improvement Activities A-05-18-00018

10-07-2021

• LEIE Database Updated with September 2021 Exclusions and Reinstatements
• Updated: Corporate Integrity Agreements

10-06-2021

• Updated: CMP and Affirmative Exclusions and Provider Self Disclosures
• Updated: Corporate Integrity Agreements

10-05-2021

• SAMHSA's Oversight Generally Ensured That the Commission on Accreditation of Rehabilitation Facilities Verified That Opioid Treatment Programs Met Federal Opioid Treatment Standards A-09-20-01002
• Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries A-01-18-00500
• Advisory Opinion 21-14 (Regarding a proposal to extend an existing discount program for chiropractic patients to include Federal health care program beneficiaries.)

10-04-2021

• Advisory Opinion 21-13 (Regarding the proposed subsidization of beneficiary cost-sharing obligations for Medicare-covered services provided as part of a clinical trial.)

10-01-2021

• Updated: Corporate Integrity Agreements

September 2021

09-30-2021

• Case Study: Missouri's Efforts To Protect Children Missing From Foster Care OEI-07-19-00372
• High-expenditure Medicare drugs often qualified for Orphan Drug Act incentives designed to encourage the development of treatments for rare diseases OEI-BL-20-00080
• New COVID-19 Enforcement Action

09-29-2021

• New COVID-19 Enforcement Actions

09-27-2021

• Updated: Corporate Integrity Agreements
• PDIG Grimm American Health Law Association Fraud and Compliance Forum Keynote
• Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Care

09-23-2021

• About Seventy-Nine Percent of Opioid Treatment Program Services Provided to Medicaid Beneficiaries in Colorado Did Not Meet Federal and State Requirements A-07-20-04118
• California Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-09-19-02004

09-22-2021

• Request for Information: Modernization Initiative To Improve HHS-OIG Public Resources
• Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments To Disproportionately Drive Payments OEI-03-17-00474

09-21-2021

• New Mexico Medicaid Fraud Control Unit: 2020 Review OEI-06-20-00550
• Opportunities Exist To Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid OEI-02-19-00401
• States Reported Multiple Challenges With Using Telehealth To Provide Behavioral Health Services to Medicaid Enrollees OEI-02-19-00400
• Indian Health Service Use of Critical Care Response Teams Has Helped To Meet Facility Needs During the COVID-19 Pandemic OEI-06-20-00700

09-17-2021

• 2021 National Health Care Fraud Enforcement Action
• Updated: Work Plan

09-16-2021

• HHS Needs to Improve Contingency Planning Oversight of its IT Systems A-18-20-04007

09-15-2021

• Advisory Opinion 21-12 (Regarding a critical access hospital's proposal to offer an arrangement similar to a warranty to patients undergoing certain joint replacement procedures at the hospital.)

09-14-2021

• Updated: Corporate Integrity Agreements

09-13-2021

• New COVID-19 Enforcement Action

09-10-2021

• An Ophthalmology Clinic in Florida: Audit of Medicare Payments for Eye Injections of Avastin, Eylea, and Lucentis A-09-19-03025
• LEIE Database Updated with August 2021 Exclusions and Reinstatements
• 2022 Spring OIG Health Care Fraud and Abuse Legal Internship

09-09-2021

• Colorado Did Not Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-17-06075
• South Carolina Medicaid Fraud Control Unit: 2020 Inspection OEI-02-20-00610

09-03-2021

• Updated: Corporate Integrity Agreements
• CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data A-09-20-02005

09-02-2021

• Kansas Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-07-20-05125

09-01-2021

• The National Human Genome Research Institute Should Strengthen Procedures in Its Pre-Award Process To Assess Risk for Certain Foreign and Higher Risk Applicants A-05-20-00026
• Medicare Beneficiaries Hospitalized With COVID-19 Experienced a Wide Range of Serious, Complex Conditions OEI-02-20-00410

August 2021

08-31-2021

• Updated: Corporate Integrity Agreements

08-27-2021

• CGS Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00613
• Foreign Assistance to Combat HIV/AIDS, Tuberculosis, and Malaria: Fiscal Year 2022 Inspectors General Coordinated PEPFAR Oversight Plan A-04-21-01023

08-26-2021

• CGS Administrators, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00612
• CMS Needs To Issue Regulations Related to Phlebotomy Travel Allowances A-06-20-04000

08-25-2021

• Job Opening: Associate Counsel for Exclusions

08-24-2021

• Although CDC Implemented Our Prior Audit Recommendations, Its Corrective Actions Did Not Effectively Address Findings Related to 3 of Our 13 Recommendations A-04-19-01014

08-23-2021

• Oklahoma's Oversight of Medicaid Outpatient Services for Opioid Use Disorder Was Generally Effective A-06-20-08000

08-20-2021

• Medicare Home Health Agency Provider Compliance Audit: Catholic Home Care A-02-19-01013

08-19-2021

• CGS Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00593
• Louisiana Medicaid Fraud Control Unit: 2020 Inspection OEI-12-20-00650
• Advisory Opinion 21-11 (Regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby an insurance company contracts with a prefer
• Medicare Hospital Provider Compliance Audit: Jewish Hospital A-04-19-08077
• CGS Administrators, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00608

08-17-2021

• Updated: Corporate Integrity Agreements
• Mississippi Medicaid Fraud Control Unit: 2020 Inspection OEI-12-20-00200
• New COVID-19 Enforcement Action
• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2021 OEI-03-21-00080

08-16-2021

• Updated: COVID-19 Fraud Alert Information
• Medicare Paid New Hospitals Three Times More for Their Capital Costs Than They Would Have Been Paid Under the Inpatient Prospective Payment System A-07-19-02818
• Missouri Claimed Federal Reimbursement for $3.4 Million in Payments to Health Home Providers That Did Not Meet Medicaid Requirements A-07-20-04117
• Updated: Work Plan

08-13-2021

• Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00616

08-12-2021

• Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00614
• Companion Data Services, LLC, Supplemental Executive Retirement Plan III Costs Claimed Through Incurred Cost Proposals Were Allowable and Reasonable A-07-21-00611
• Concerns Persist about Opioid Overdoses and Medicare Beneficiaries' Access to Treatment and Overdose-Reversal Drugs OEI-02-20-00401
• Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00615

08-11-2021

• Companion Data Services, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00610
• Palmetto Government Benefits Administrator, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00592
• Companion Data Services, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00609

08-10-2021

• Almost All of the Medicare Pension Costs That Companion Data Services, LLC, Claimed Through Its Incurred Cost Proposals Were Allowable A-07-20-00594
• LEIE Database Updated with July 2021 Exclusions and Reinstatements
• Updated: CMP and Affirmative Exclusions and Provider Self Disclosures

08-09-2021

• Medicare Continues To Make Overpayments for Chronic Care Management Services, Costing the Program and Its Beneficiaries Millions of Dollars A-07-19-05122
• Updated: COVID-19 Fraud Alert Information

08-06-2021

• Nationwide, Almost All Medicaid Managed Care Plans Achieved Their Medical Loss Ratio Targets OEI-03-20-00230
• Advisory Opinion 21-10 (Regarding a dental provider's provision of free routine and emergency dental services to certain indigent residents of skilled nursing facilities and nursing facilities.)

08-04-2021

• Updated: Work Plan
• Updated: Corporate Integrity Agreements

08-02-2021

• Updated: Work Plan
• Almost 15 Percent of Arkansas' Private Contractor Costs Were Either Unallowable or Claimed at Higher Federal Matching Rates Than Eligible, Resulting in Arkansas Inappropriately Claiming $4.4 Million i

July 2021

07-29-2021

• States' Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic OEI-01-20-00431

07-23-2021

• Texas Made Unallowable Children's Health Insurance Program Payments for Beneficiaries Assigned More Than One Identification Number A-06-20-10003

07-22-2021

• Palmetto GBA, LLC, Accurately Calculated Hospice Cap Amounts but Did Not Collect All Cap Overpayments A-06-19-08003
• New York Improperly Claimed $439 Million In Medicaid Funds for Its School-Based Health Services Based on Certified Public Expenditures A-02-18-01019

07-21-2021

• Updated: Corporate Integrity Agreements
• Updated: COVID-19 Fraud Alert Information

07-20-2021

• Updated: Fraud Risk Indicator

07-19-2021

• Advisory Opinion 21-09 (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 p

07-15-2021

• New COVID-19 Enforcement Action
• Updated: Corporate Integrity Agreements
• Updated: Work Plan

07-14-2021

• Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2020 A-18-21-11300
• Medicare Hospice Provider Compliance Audit: Partners In Care, Inc. A-09-18-03024
• FY 2020 Health Care Fraud and Abuse Control Program Report
• Audit of Medicare Part D Pharmacy Fees: Group Health Cooperative, Inc. A-03-19-00002

07-12-2021

• Medicare Hospital Provider Compliance Audit: Lake Hospital System A-05-19-00024
• Medicare Hospice Provider Compliance Audit: Mission Hospice & Home Care, Inc. A-09-18-03009
• Indiana Received Over $22 Million in Excess Federal Funds Related to Unsupported Community Integration and Habilitation Waiver Services at 12 Selected Service Providers A-05-19-00022

07-09-2021

• Medicare Payments for Transitional Care Management Services Generally Complied With Federal Requirements, but Some Overpayments Were Made A-07-17-05100
• The Centers for Medicare & Medicaid Services Did Not Account for National Security Risks in Its Enterprise Risk Management Processes A-18-20-06200
• LEIE Database Updated with June 2021 Exclusions and Reinstatements
• New York's Claims for Federal Reimbursement for Payments to Health Home Providers on Behalf of Beneficiaries Diagnosed With Serious Mental Illness or Substance Use Disorder Generally Met Medicaid Requ

07-08-2021

• Advisory Opinion 21-08 (Regarding financial assistance for transportation, lodging, and meals provided by a pharmaceutical manufacturer to certain patients potentially eligible for treatment with the
• The National Heart, Lung, and Blood Institute Did Not Fully Comply With Federal Requirements for Other Transactions A-04-20-04078
• Updated: Provider Self Disclosures
• Updated: Corporate Integrity Agreements

07-07-2021

• The Puerto Rico Department of Health's Implementation of Its Emergency Preparedness and Response Activities Before and After Hurricane Maria Was Not Effective
• Advisory Opinion 21-07 (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 p

07-06-2021

• PDIG Grimm Provides Update on Oversight of COVID-19-Related Programs

June 2021

06-30-2021

• 2020 Performance Data for the Senior Medicare Patrol Projects OEI-02-21-00180
• Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2021 OEI-05-21-00170

06-29-2021

• Updated: Civil Monetary Penalties and Affirmative Exclusions
• Advisory Opinion 21-06 (Regarding a spinal implant manufacturer�s proposal to offer its products to hospitals at a reduced price if the hospitals agree to assume certain duties related to t

06-28-2021

• CMS's Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Ho
• Medicare Hospital Provider Compliance Audit: Staten Island University Hospital A-02-18-01025

06-25-2021

• Kentucky Claimed Millions in Unallowable School-Based Medicaid Administrative Costs A-04-17-00113
• Medicare Hospice Provider Compliance Audit: Northwest Hospice, LLC A-09-20-03035

06-23-2021

• Medicare Lacks Consistent Oversight of Cybersecurity for Networked Medical Devices in Hospitals OEI-01-20-00220

06-22-2021

• COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020 OEI-02-20-00490
• New Featured Topic: Nursing Homes

06-16-2021

• SAMHSA Is Missing Opportunities To Better Monitor Access to Medication Assisted Treatment Through the Buprenorphine Waiver Program OEI-BL-20-00260

06-15-2021

• Updated: Work Plan
• Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2019 Average Sales Prices OEI-03-21-00130
• Selected NIH Institutes Met Requirements for Documenting Peer Review But Could Do More To Track and Explain Funding Decisions OEI-01-19-00140

06-14-2021

• California Did Not Ensure That Nursing Facilities Always Reported Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Properly A-09-19-02005
• Nebraska Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for 76 Percent of the State's Medicaid Fraud Control Unit Cases A-07-18-02814

06-11-2021

• Medicare Hospice Provider Compliance Audit: Professional Healthcare at Home, LLC A-09-18-03028

06-09-2021

• Updated: Provider Self Disclosures
• Opportunities Exist for CMS and Its Medicare Contractors To Strengthen Program Safeguards To Prevent and Detect Improper Payments for Drug Testing Services A-09-20-03017

06-08-2021

• LEIE Database Updated with May 2021 Exclusions and Reinstatements

06-04-2021

• Updated: Corporate Integrity Agreements
• University of Michigan Health System: Audit of Medicare Payments for Polysomnography Services A-04-20-07088

06-03-2021

• New COVID-19 Enforcement Action
• New Mexico Did Not Bill Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-06-16-00001
• Updated: Work Plan

06-01-2021

• Medicare Home Health Agency Provider Compliance Audit: Caretenders of Jacksonville, LLC A-04-16-06195
• Gateway Community Action Partnership Claimed Unallowable Costs, Did Not Comply With Federal Regulations on Construction and Major Renovations, and Did Not Accurately Account for Grant Funds A-02-18-02

May 2021

05-28-2021

• FY 2022 Congressional Budget Justification
• Spring 2021 Semiannual Report to Congress
• Updated: Corporate Integrity Agreements

05-27-2021

• Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments A-07-19-05117
• Updated: Corporate Integrity Agreements
• Toolkit: Insights from OIG's Work on the Office of Refugee Resettlement's Efforts To Care for Unaccompanied Children OEI-09-21-00220
• Blue Cross Blue Shield of South Carolina Overstated Its Excess Plan Partial Medicare Segment Pension Assets as of January 1, 2017 A-07-21-00607

05-26-2021

• 2021 National COVID-19 Health Care Fraud Takedown

05-24-2021

• Updated COVID-19 FAQs
• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS A-07-19-01187

05-21-2021

• Sleep Management, LLC: Audit of Claims for Monthly Rental of Noninvasive Home Ventilators A-04-18-04066

05-20-2021

• Medicare Hospice Provider Compliance Audit: Franciscan Hospice A-09-20-03034
• Updated: Corporate Integrity Agreements
• Advisory Opinion 21-05 (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 p

05-19-2021

• Advisory Opinion 21-04 (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 p
• New York Did Not Have Adequate Oversight of Its Reported Temporary Assistance for Needy Families Program Expenditures A-02-17-02005

05-18-2021

• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2020 OEI-03-21-00070
• Medicare Hospice Provider Compliance Audit: Alive Hospice, Inc. A-09-18-03016
• Medicare Hospice Provider Compliance Audit: Ambercare Hospice, Inc. A-09-18-03017
• New COVID-19 Enforcement Action

05-17-2021

• Advisory Opinion 21-03 (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 p
• NEW: Behavioral Health-Medication-Assisted Treatment Viewer
• Updated: Work Plan
• U.S. 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 Fiscal Y
• CMS Needs to Strengthen Regulatory Requirements for Medicare Part B Outpatient Cardiac and Pulmonary Rehabilitation Services to Ensure Providers Fully Meet Coverage Requirements A-02-18-01026

05-14-2021

• Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00032

05-13-2021

• New York Made Unallowable Payments Totaling More Than $9 Million to the Same Managed Care Organization for Beneficiaries Assigned More Than One Medicaid Identification Number A-02-20-01007

05-12-2021

• Medicare Could Have Saved up to $20 Million Over 5 Years if CMS Oversight Had Been Adequate To Prevent Payments for Medically Unnecessary Cholesterol Blood Tests A-09-19-03027

05-11-2021

• Updated: Corporate Integrity Agreements
• Risk Assessment of the Food and Drug Administration's Travel Card Program A-04-19-06235
• New COVID-19 Enforcement Action

05-10-2021

• Medicare Hospice Provider Compliance Audit: Suncoast Hospice A-02-18-01001

05-07-2021

• Louisiana Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-02005
• The Substance Abuse and Mental Health Services Administration Generally Had Controls and Strategies for Mitigating Disaster Preparedness and Response Risks A-04-20-02026
• Updated: Corporate Integrity Agreements

05-06-2021

• Updated: CIA Reportable Events and Provider Self Disclosures
• CMS Could Improve the Data It Uses To Monitor Antipsychotic Drugs in Nursing Homes OEI-07-19-00490

05-05-2021

• Updated: Corporate Integrity Agreements
• Updated COVID-19 FAQs
• Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital A-02-18-01018

05-03-2021

• LEIE Database Updated with April 2021 Exclusions and Reinstatements

April 2021

04-29-2021

• Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Maryland A-03-17-00009
• New Video: HHS-OIG Update on Compliance
• Advisory Opinion 21-02 (regarding an investment by a health system, certain surgeons, and a management company in an ambulatory surgery center.)

04-27-2021

• Updated: Civil Monetary Penalties and Affirmative Exclusions
• Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds A-06-19-02000

04-26-2021

• Updated: Corporate Integrity Agreements

04-23-2021

• Office of Inspector General's Partnership with the Office of the New York State Comptroller: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare A-02-21-01008
• New Whistleblower Protection Information Brochure

04-22-2021

• Testimony of Gary L. Cantrell , Deputy Inspector General, Office of Investigations, Office of Inspector General, U.S. House Committee on Health, Education, Labor and Pensions: Protecting U.S. Biomedic
• HHS-OIG Update on Compliance : Principal Deputy Inspector General Christi A. Grimm speaks at the HCCA 25th Annual Compliance Institute

04-21-2021

• Colorado's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 18 of 30 Providers Reviewed A-07-19-06084

04-20-2021

• Medicare Advantage Compliance Audit of Diagnosis Codes That Humana, Inc., (Contract H1036) Submitted to CMS A-07-16-01165

04-16-2021

• Updated: Fraud Risk Indicator

04-15-2021

• Message from HHS-OIG Leadership on the COVID-19 Vaccination Program and Provider Compliance
• Mensaje de la PDIG sobre el programa de vacunaci�n contra el COVID-19 y (acatamiento) del proveedor
• Updated: Work Plan

04-13-2021

• Georgia Generally Ensured That Nursing Facilities Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Prioritized Allegations Timely A-04-17-03084

04-12-2021

• Updated: Corporate Integrity Agreements
• Blue Cross Blue Shield of South Carolina Overstated Its Supplemental Executive Retirement Plan III Medicare Allowable Segment Pension Assets as of January 1, 2017 A-07-20-00600

04-09-2021

• Review of the Department of Health and Human Services' Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2020 A-18-20-11200
• Palmetto Government Benefits Administrator, LLC, Overstated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00598
• Noridian Healthcare Solutions, LLC, Claimed Unallowable Medicare Nonqualified Restoration Savings Plan Costs Through Its Incurred Cost Proposals A-07-20-00591
• Updated: Civil Monetary Penalties and Affirmative Exclusions, CIA Reportable Events, and Provider Self Disclosures
• CNN Op-Ed by Christi A. Grimm & Michael E. Horowitz: Four crucial lessons for improving Covid-19 testing
• New COVID-19 Enforcement Actions

04-07-2021

• Summary Report for Cybersecurity Assessments of Four HHS Operating Division Networks A-18-20-08012

04-06-2021

• Medicare Advantage Organizations Are Missing Opportunities To Use Ordering Provider Identifiers To Protect Program Integrity OEI-03-19-00432

04-01-2021

• Medicare Hospital Provider Compliance Audit: Sunrise Hospital & Medical Center A-04-19-08075

March 2021

03-30-2021

• Data on Medicaid Managed Care Payments to Providers Are Incomplete and Inaccurate OEI-02-19-00180
• An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis A-09-19-03022

03-29-2021

• Illinois Medicaid Fraud Control Unit: 2019 Onsite Review OEI-06-19-00510

03-25-2021

• Companion Data Services, LLC, Properly Updated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-21-00606
• Updated: Corporate Integrity Agreements

03-24-2021

• Updated: COVID-19 FAQs
• Hospitals Reported That the COVID-19 Pandemic Has Significantly Strained Health Care Delivery OEI-09-21-00140
• Advisory Opinion 21-01 (regarding a free drug provided by a pharmaceutical manufacturer to certain patients to whom the manufacturer's drug has been prescribed.)

03-19-2021

• Medicaid Fraud Control Units Fiscal Year 2020 Annual Report OEI-09-21-00120

03-18-2021

• North Mississippi Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07086
• Updated: Corporate Integrity Agreements

03-15-2021

• Updated: Work Plan

03-12-2021

• HHS Operating Division Generally Implemented Cybersecurity Controls Over Key Reporting System But Improvements Are Needed A-18-20-06001

03-11-2021

• CMS Use of Data on Nursing Home Staffing: Progress and Opportunities To Do More OEI-04-18-00451

03-10-2021

• LEIE Database Updated with February 2021 Exclusions and Reinstatements

03-08-2021

• Peninsula Regional Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07087
• Florida Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Did Not Always Assess, Prioritize, or Investigate Reported Incide
• Updated: Provider Self-Disclosure Settlements
• Updated: Civil Monetary Penalties and Affirmative Exclusions
• Updated: Grant Fraud Self-Disclosure Settlements

03-05-2021

• Updated COVID-19 Fraud Alert Information
• Updated: Corporate Integrity Agreements

03-03-2021

• CMS Authorized Hundreds of Millions of Dollars in Advanced Premium Tax Credits on Behalf of Enrollees Who Did Not Make Their Required Premium Payments A-02-19-02005
• Updated: Corporate Integrity Agreements

03-02-2021

• ACF Cannot Ensure That All Child Victims of Abuse and Neglect Have Court Representation OEI-12-16-00120

03-01-2021

• STAT Op-Ed by Christi A. Grimm & Julie K. Taitsman: Why drug prescriptions should include diagnoses

February 2021

02-26-2021

• Message from HHS-OIG Leadership on Telehealth
• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross Blue Shield of Michigan (Contract H9572) Submitted to CMS A-02-18-01028
• Updated: Corporate Integrity Agreements
• 2021 Fall OIG Health Care Fraud and Abuse Legal Internship

02-24-2021

• Medicare Hospice Provider Compliance Audit: Tidewell Hospice, Inc. A-02-18-01024
• Virginia's Monitoring Did Not Ensure Child Care Provider Compliance With State Criminal Background Check Requirements at 8 of 30 Providers Reviewed A-03-19-00253
• Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged Before COVID-19 and Warrants Further Scrutiny OEI-02-18-00380
• Updated: Corporate Integrity Agreements

02-23-2021

• Although the Bemidji Area Office Had Adequate Procedures To Disburse Indian Health Service Funds, It Needs To Strengthen Its Procedures for Monitoring the Use of the Funds A-05-18-00019

02-22-2021

• Noridian Healthcare Solutions, LLC, Made Improper Medicare Payments of $4 Million to Physicians in Jurisdiction E for Spinal Facet-Joint Injections A-09-20-03010

02-18-2021

• Updated: Provider Self-Disclosure Settlements

02-17-2021

• Updated: Corporate Integrity Agreements
• New York Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-02-17-01026
• Updated: COVID-19 FAQs

02-16-2021

• Iowa Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-19-03238
• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2020 OEI-03-21-00060
• Updated: Work Plan

02-11-2021

• Illinois Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00031

02-10-2021

• LEIE Database Updated with January 2021 Exclusions and Reinstatements

02-04-2021

• Opioid Use in Medicare Part D During the Onset of the COVID-19 Pandemic OEI-02-20-00400
• Updated: Corporate Integrity Agreements

02-02-2021

• Updated Stipulated Penalties and Exclusion for Material Breach
• Updated Civil Monetary Penalties and Affirmative Exclusions

January 2021

01-29-2021

• Louisiana Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-06-18-02000
• 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-Rel
• Updated: Work Plan

01-28-2021

• Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program A-01-19-00004
• California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider's Opioid Treatment Program Services A-09-20-02001

01-25-2021

• Updated: Corporate Integrity Agreements
• Updated Provider Self-Disclosure Settlements

01-21-2021

• Independent Attestation Review: Substance Abuse and Mental Health Services Administration Fiscal Year 2020 Detailed Accounting Report, Performance Summary Report for National Drug Control Activities,

01-20-2021

• Updated: Work Plan
• Choctaw Nation of Oklahoma Made Progress Toward Meeting Program Goals During the First Year of Its Tribal Opioid Response Grant A-07-20-04121

01-19-2021

• CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing Program Data To Identify and Focus on Error-Prone Providers A-05-17-00023

01-15-2021

• Medicare Home Health Agency Provider Compliance Audit: Southeastern Home Health Services
• Updated: Work Plan

01-14-2021

• Updated: Fraud Risk Indicator
• Federal COVID-19 Testing Report: Data Insights from Six Federal Health Programs Press Release

01-13-2021

• Independent Attestation Review: Centers for Disease Control and Prevention Fiscal Year 2020 Detailed Accounting Report, Performance Summary Report for National Drug Control Activities, Budget Formulat
• Independent Attestation Review: Health Resources and Services Administration Fiscal Year 2020 Detailed Accounting Report, Performance Summary Report for National Drug Control Activities, Budget Formul
• Independent Attestation Review: National Institutes of Health Fiscal Year 2020 Detailed Accounting Report, Performance Summary Report for National Drug Control Activities, Budget Formulation Complianc
• Independent Attestation Review: Indian Health Service Fiscal Year 2020 Detailed Accounting Report, Performance Summary Report for National Drug Control Activities, Budget Formulation Compliance Report

01-08-2021

• Updated: Corporate Integrity Agreements

01-07-2021

• Ohio Made Progress Toward Achieving Program Goals for Enhancing Its Prescription Drug Monitoring Program A-05-18-00004
• LEIE Database Updated with December 2020 Exclusions and Reinstatements

01-05-2021

• Updated: Corporate Integrity Agreements