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What's New

See also: Archive


Las imprecisiones en los datos de raza y origen étnico de Medicare dificultan la evaluación de disparidades en la salud OEI-02-21-00100
The National Institutes of Health Did Not Ensure That All Clinical Trial Results Were Reported in Accordance With Federal Requirements A-06-21-07000
The National Institutes of Health Administered Superfund Appropriations During Fiscal Year 2021 in Accordance With Federal Requirements A-04-22-04088
Part D Plan Preference for Higher-Cost Hepatitis C Drugs Led to Higher Medicare and Beneficiary Spending OEI-BL-21-00200
South Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-07003
Updated: Corporate Integrity Agreements
Updated: Corporate Integrity Agreements
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2021 A-18-22-11300
Updated: Fraud Risk Indicator
Statement on the Passing of Former Inspector General June Gibbs Brown
LEIE Database Updated with July 2022 Exclusions and Reinstatements


Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00005
Employee Profile: Eyana J. Esters
CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits A-04-18-03085
Updated: Civil Monetary Penalties and Affirmative Exclusions
Medicare Critical Care Services Provider Compliance Audit: Lahey Clinic, Inc. A-03-20-00002
Special Fraud Alert: OIG Alerts Practitioners To Exercise Caution When Entering Into Arrangements With Purported Telemedicine Companies
2022 National Health Care Fraud Enforcement Action
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cariten Health Plan, Inc., (Contract H4461) Submitted to CMS A-02-20-01009
Updated: Corporate Integrity Agreements
Updated: Work Plan
Audits of Nursing Home Life Safety and Emergency Preparedness in Eight States Identified Noncompliance With Federal Requirements and Opportunities for the Centers for Medicare & Medicaid Services to Improve Resident, Visitor, and Staff Safety A-02-21-01010
Job Openings: Office of Counsel Attorney Positions
CDC Found Ways To Use Data To Understand and Address COVID-19 Health Disparities, Despite Challenges With Existing Data OEI-05-20-00540
Medicare Hospice Provider Compliance Audit: Vitas Healthcare Corporation of Florida A-02-19-01018
Updated: Fraud Self-Disclosures
LEIE Database Updated with June 2022 Exclusions and Reinstatements
Updated: Corporate Integrity Agreements
In Five States, There Was No Evidence That Many Children in Foster Care Had a Screening for Sex Trafficking When They Returned After Going Missing OEI-07-19-00371
The Reduced Outlier Threshold Applied to Transfer Claims Did Not Significantly Increase Medicare Payments to Hospitals A-05-19-00019
2021 Health Care Fraud and Abuse Control Program Report
Advisory Opinion 22-15 (Regarding a proposal to use donations to cover: (i) specialized care furnished to veterans who meet certain criteria; and (ii) certain out-of-pocket expenses related to that specialized care. )
The Centers for Medicare & Medicaid Services Had Policies and Procedures in Place To Mitigate Vulnerabilities in a Timely Manner, but Improvements Are Needed A-18-20-06500
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2022 OEI-05-22-00230


The Food and Drug Administration's Foreign For-Cause Drug Inspection Program Can Be Improved To Protect the Nation's Drug Supply A-01-19-01500
Advisory Opinion 22-14 (regarding an ophthalmology practice’s proposed continuing education programs for local optometrists and four financing options to fund the programs.)
Justice Department’s Criminal Division Creates New England Prescription Opioid Strike Force to Focus on Illegal Opioid Prescriptions
Testimony of Erin Bliss, Assistant Inspector General, Office of Evaluation and Inspections, Office of Inspector General, United States House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, Testimony to Protecting America’s Seniors: Oversight of Private Sector Medicare Advantage Plans
More Than 90 Percent of the New Hampshire Managed Care Organization and Fee-for-Service Claims for Opioid Treatment Program Services Did Not Comply With Medicaid Requirements A-01-20-00006
An Estimated 91 Percent of Nursing Home Staff Nationwide Received the Required COVID-19 Vaccine Doses, and an Estimated 56 Percent of Staff Nationwide Received a Booster Dose A-09-22-02003
Office of Refugee Resettlement's Influx Care Facility and Emergency Intake Sites Did Not Adequately Safeguard Unaccompanied Children From COVID-19 A-06-21-07002
Advisory Opinion 22-13 (regarding a durable medical equipment manufacturer's arrangements with two financial institutions to make zero-interest financing available to qualified customers.)
Updated: Corporate Integrity Agreements
Iowa Medicaid Fraud Control Unit: 2021 Inspection OEI-07-21-00340
Updated: Corporate Integrity Agreements
Updated: Civil Monetary Penalties and Affirmative Exclusions
STAT Op-Ed by Christi A. Grimm, Ruth Ann Dorrill, & Julie K. Taitsman: New report: gains in patient safety have stalled over the past decade
Inaccuracies in Medicare's Race and Ethnicity Data Hinder the Ability To Assess Health Disparities OEI-02-21-00100
Eye on Oversight Video: Inaccuracies in Medicare’s Race and Ethnicity Data
Updated: Work Plan
2021 Performance Data for the Senior Medicare Patrol Projects OEI-02-22-00310
Medicare and Beneficiaries Paid Substantially More to Provider-Based Facilities in Eight Selected States in Calendar Years 2010 Through 2017 Than They Paid to Freestanding Facilities in the Same States for the Same Type of Services A-07-18-02815
Updated: Corporate Integrity Agreements
LEIE Database Updated with May 2022 Exclusions and Reinstatements
Updated: Fraud Self-Disclosures
Opportunities Exist To Strengthen NIH Grantees' Oversight of Investigators' Foreign Significant Financial Interests and Other Support OEI-03-20-00210
Maine Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00007
Spring 2022 Semiannual Report to Congress
California Collected and Disbursed Stimulus Payments and Income Tax Refunds Under the Federal Tax Refund Offset Program in Accordance With Federal and State Requirements A-01-21-01501
Texas Did Not Report and Return All Medicaid Overpayments for the State's Medicaid Fraud Control Unit's Cases A-06-20-04004
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Peoples Health Network (Contract H1961) Submitted to CMS A-06-18-05002
Updated Work Plan: Food and Drug Administration's Actions Regarding the Abbott Infant Formula Recall
Cost Allocation Services Needs To Update Its Indirect Cost Rate-Setting Guidance 06-01-2022
Vanderbilt University Medical Center: Audit of Outpatient Outlier Payments A-06-20-04003
Medicare Improperly Paid Durable Medical Equipment Suppliers an Estimated $8 Million of the $40 Million Paid for Power Mobility Device Repairs A-09-20-03016
Advisory Opinion 22-12 (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. )
Modification of Advisory Opinion 20-02 (Requestor now seeks to modify AO 20-02 to include Requestor’s provision of financial assistance to eligible patients for travel, lodging, and certain other associated expenses in connection with a round trip to an approved treatment center for a cell-removal process associated with manufacturing Requestor’s drug. )


Updated: Corporate Integrity Agreements
Selected Dialysis Companies Implemented Additional Infection Control Policies and Procedures To Protect Beneficiaries and Employees During the COVID-19 Pandemic A-05-20-00052
Advisory Opinion 22-11 (Regarding its proposal to employ an individual who is excluded from participation in Federal health care programs to perform marketing tasks relating to workers’ compensation programs.)
Press Release: HHS-OIG Issues Notice of Exclusion to Owner of 7 Louisiana Nursing Homes
National Snapshot of State Agency Approaches To Reporting and Locating Children Missing From Foster Care A-07-20-06095
Employee Profile: Jessica Yun Kim
New AI/AN Training: Improving Health and Well-Being in American Indian and Alaska Native Communities Through Compliance
Washington State Did Not Comply With Federal and State Requirements for Claiming Enhanced Federal Reimbursement for Medicaid Managed-Care Health Home Service Expenditures A-09-20-02008
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2021 OEI-03-22-00200
Updated: Work Plan
Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018 OEI-06-18-00400
National Background Check Program for Long-Term-Care Providers: An Interim Assessment OEI-07-20-00181
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 2021 A-17-22-52000
LEIE Database Updated with April 2022 Exclusions and Reinstatements
2022 Fall OIG Health Care Fraud and Abuse Legal Internship
Employee Profile: Jim Korn
Updated: Corporate Integrity Agreements
Updated: Fraud Self-Disclosures
2022 Opioid Enforcement Action
HHS Should Improve Internal Coordination Regarding Unaccompanied Children OEI-BL-20-00670
Updated: Civil Monetary Penalties and Affirmative Exclusions
Advisory Opinion 22-10 - Modification of Advisory Opinion 15-14 (Regarding (i) a modification to OIG Advisory Opinion 15-14, issued to the requestor on November 13, 2015, to include within the scope of that opinion, the requestor’s proposal to provide financial assistance for certain past magnetic resonance imaging tests; and (ii) a second arrangement regarding the distribution of certain cooling and mobility items, ancillary to the arrangement addressed in OIG Advisory Opinion 15-14.)


Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care OEI-09-18-00260
Eye on Oversight Video: Medicare Advantage Denials of Care
National Snapshot of Trends in the National Domestic Violence Hotline's Contact Data Before and During the COVID-19 Pandemic A-09-21-06000
Advisory Opinion 22-09 (Regarding a proposed arrangement pursuant to which Requestor would compensate hospitals for certain specimen collection services for laboratory tests furnished by Requestor.)
Advisory Opinion 22-08 (Regarding an arrangement whereby certain existing patients of Requestor use limited-use smartphones that Requestor loaned to such patients to facilitate access to telehealth services.)
Review of the Department of Health and Human Services' Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2021 A-18-21-11200
Massachusetts Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00003
Advisory Opinion 22-07 (Regarding an arrangement whereby certain physicians have an ownership interest in a medical device company that manufactures products that may be ordered by the physician owners and a physician spouse of one of the physician owners.)
California Improperly Claimed at Least $23 Million of $260 Million in Total Medicaid Reimbursement for Opioid Treatment Program Services A-09-20-02009
Updated: Fraud Risk Indicator
2022 National COVID-19 Health Care Fraud Enforcement Action
Updated: Corporate Integrity Agreements
Updated: Work Plan
Updated: Corporate Integrity Agreements
Louisiana Faced Compliance and Contracting Challenges in Implementing Opioid Response Grant Programs A-06-20-07003
Advisory Opinion 22-06 Regarding the provision of free genetic testing and genetic counseling services to individuals who meet specified clinical criteria.
Updated: Corporate Integrity Agreements
LEIE Database Updated with March 2022 Exclusions and Reinstatements
Posthospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries in Indiana Generally Met Medicare Level-of-Care Requirements A-05-20-00005
New COVID-19 Enforcement Action
Updated: CIA Reportable Events, CMP and Affirmative Exclusions, and Fraud Self-Disclosures
Updated: Corporate Integrity Agreements
Featured Topic: Telehealth
South Carolina Did Not Fully Comply With Requirements for Reporting and Monitoring Critical Events Involving Medicaid Beneficiaries With Developmental Disabilities A-04-18-07078


Medicare Part D and Beneficiaries Could Realize Significant Spending Reductions With Increased Biosimilar Use OEI-05-20-00480
Inspector General Grimm HCCA 26th Annual Compliance Institute Keynote
Psychotherapy Services Billed by a New York City Provider Did Not Comply With Medicare Requirements A-02-21-01006
FY 2023 Congressional Budget Justification
Employee Profile: Rosemary Bartholomew
New Mexico Did Not Claim $12.4 Million of $222.6 Million in Medicaid Payments for Services Provided by Indian Health Service Facilities in Accordance With Federal and State Requirements A-06-19-09005
Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic OEI-02-20-00520
Updated: Civil Monetary Penalties and Affirmative Exclusions
New COVID-19 Enforcement Action
Advisory Opinion 22-05 Regarding the proposed subsidization of certain Medicare cost-sharing obligations in the context of a clinical trial.
New York Verified That Medicaid Assisted Living Program Providers Met Life Safety and Emergency Planning Requirements But Did Not Always Ensure That Assisted Living Program Services Met Federal and State Requirements A-02-19-01017
Updated: Work Plan
Medicaid Fraud Control Units Fiscal Year 2021 Annual Report OEI-09-22-00020
New Video: Our Impact: HHS-OIG
LEIE Database Updated with February 2022 Exclusions and Reinstatements
New Jersey's Medicaid School-Based Cost Settlement Process Could Result in Claims That Do Not Meet Federal Requirements A-02-20-01012
Updated: Corporate Integrity Agreements
Updated: Fraud Self-Disclosures
The Centers for Medicare & Medicaid Services' Eligibility Review Contractor Adequately Determined Medicaid Eligibility for Selected States Under the Payment Error Rate Measurement Program A-02-20-01006
New COVID-19 Enforcement Action
Updated: Corporate Integrity Agreements
Leadership Update
Advisory Opinion 22-04 (Regarding a program through which Requestor provides certain individuals access to digital contingency management and related tools to treat substance use disorders, where the Program is funded by customers, which could include individuals’ health care providers or suppliers.)
Texas Did Not Ensure Documentation Supported That Individuals Met Eligibility Requirements and That Its Annual Report Was Accurate Under Its Projects for Assistance in Transition From Homelessness Program A-02-21-02001


Employee Profile: Angela Grimes
Hospitals Did Not Always Meet Differing Medicare Contractor Specifications for Bariatric Surgery A-09-20-03007
Office of Inspector General's Partnership With the Oregon Secretary of State's Audits Division: Oregon Health Authority-Timely Notification of Inpatient Hospital Stays Could Help Reduce Improper Medicaid Payments A-09-22-02001
Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2021 OEI-03-22-00190
Updated: Corporate Integrity Agreements
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Tufts Health Plan (Contract H2256) Submitted to CMS A-01-19-00500
Medicare Payments of $6.6 Billion to Nonhospice Providers Over 10 Years for Items and Services Provided to Hospice Beneficiaries Suggest the Need for Increased Oversight A-09-20-03015
Updated: Work Plan
Office of Refugee Resettlement Generally Ensured That Selected Care Provider Facilities for Its Unaccompanied Children Program Complied With Federal Emergency Preparedness Requirements A-04-20-02025
Advisory Opinion 22-03 (Regarding Requestors’ proposal to pay salaries to, and nurse aide certification program tuition costs on behalf of, new employees who Requestors have hired to work as certified nurse aides for Requestors’ home health agencies.)
LEIE Database Updated with January 2022 Exclusions and Reinstatements
Updated: Health Care Fraud Self-Disclosures
Advisory Opinion 22-02 (Regarding a proposed arrangement between Requestor and two individuals, pursuant to which Requestor and the individuals would reduce and subsidize certain costs incurred by qualifying patients of Requestor’s children’s hospital.)
The National Institutes of Health Could Improve Its Post-Award Process for the Oversight and Monitoring of Grant Awards A-03-20-03001
Findings of Whistleblower Retaliation by CDC Central America Regional HIV Program Management Official
Updated: Corporate Integrity Agreements
Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan (Contract H5425) Submitted to CMS A-07-17-01169
Updated: Civil Monetary Penalties and Affirmative Exclusions
Prior Audits of Medicaid Eligibility Determinations in Four States Identified Millions of Beneficiaries Who Did Not or May Not Have Met Eligibility Requirements A-02-20-01018
Updated: Corporate Integrity Agreements
Updated: Fraud Risk Indicator
Independent Attestation Report: Food and Drug Administration Budget Formulation Compliance Report and Detailed Accounting Submission for Fiscal Year 2021 National Drug Control Activities, and Accompanying Required Assertions A-03-22-00352


The Assistant Secretary for Administration Awarded and Managed Five Sole Source Contracts for COVID-19 Testing in Accordance With Federal and Contract Requirements A-05-21-00014
HHS's Suspension and Debarment Program Helped Safeguard Federal Funding, But Opportunities for Improvement Exist OEI-04-19-00570
Independent Attestation Review: Centers for Medicare & Medicaid Services Fiscal Year 2021 Detailed Accounting Submission and Budget Formulation Compliance Report for National Drug Control Activities, and Accompanying Required Assertions A-03-22-00351
New COVID-19 Enforcement Action
Updated: Civil Monetary Penalties and Affirmative Exclusions
Advisory Opinion 22-01 (Regarding the proposed expansion of discount programs for low-income individuals.)
CMS Should Take Further Action To Address States With Poor Performance in Conducting Nursing Home Surveys OEI-06-19-00460
Updated: Corporate Integrity Agreements
Updated: Work Plan
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-04-21-06254
New COVID-19 Enforcement Action
Updated: Corporate Integrity Agreements
Updated: Health Care Fraud Self-Disclosures
Updated: CMP and Affirmative Exclusions and CIA Reportable Events
LEIE Database Updated with December 2021 Exclusions and Reinstatements
Updated: Corporate Integrity Agreements
Job Openings: Office of Counsel Attorney Positions
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Healthfirst Health Plan, Inc., (Contract H3359) Submitted to CMS A-02-18-01029
Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Excess Pension Assets as of December 31, 2016 A-07-21-00603
Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2014 Through 2016 A-07-21-00602
Updated: Corporate Integrity Agreements
Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals for Calendar Years 2014 Through 2016 A-07-21-00605
Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Postretirement Benefit Assets as of January 1, 2017 A-07-21-00604
COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of Non-COVID-19 Tests Decreased Significantly OEI-09-21-00240
Louisiana's Monitoring Did Not Ensure Child Care Provider Compliance With Criminal Background Check Requirements at 8 of 30 Providers Reviewed A-06-19-02001