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Centers for Medicare and Medicaid Services (CMS)

CMS Document Archive

2023

11-27-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That SelectCare of Texas, Inc. (Contract H4506), Submitted to CMS A-06-19-05002
11-24-2023
Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees' Deaths A-04-21-09005
11-16-2023
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2022 A-18-23-11300
11-08-2023
Pennsylvania Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control A-03-22-00206
11-07-2023
CMS Can Do More To Leverage Medicare Claims Data To Identify Unreported Incidents of Potential Abuse or Neglect A-01-22-00501
11-01-2023
Noridian Healthcare Solutions Reopened and Corrected Cost Report Final Settlements To Collect $11 Million in Net Overpayments That Had Been Made to Medicare Providers A-06-22-05000
10-26-2023
Medicare Advantage Compliance Audit of Diagnosis Codes That CarePlus Health Plans, Inc. (Contract H1019) Submitted to CMS A-04-19-07082
10-20-2023
States Face Ongoing Challenges in Meeting Third-Party Liability Requirements for Ensuring That Medicaid Functions as the Payer of Last Resort A-05-21-00013
10-18-2023
South Dakota MMIS and E&E System Security Controls Were Partially Effective and Improvements Are Needed A-18-21-09004
Mississippi Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-21-06103
10-06-2023
Medicare Could Save Millions if It Implements an Expanded Hospital Transfer Payment Policy for Discharges to Postacute Care A-01-21-00504
10-02-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Aetna, Inc. (Contract H5521) Submitted to CMS A-01-18-00504
09-29-2023
New Jersey Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control A-02-22-01004
09-25-2023
Home Health Agencies Rarely Furnished Services Via Telehealth Early in the COVID-19 Public Health Emergency A-05-21-00026
09-22-2023
Medicare Advantage Compliance Audit of Diagnosis Codes That Health Net of California, Inc. (Contract H0562) Submitted to CMS A-09-18-03007
Four States Reviewed Received Increased Medicaid COVID-19 Funding Even Though They Terminated Some Enrollees' Coverage for Unallowable or Potentially Unallowable Reasons A-06-21-09002
09-21-2023
Alabama Did Not Always Invoice Rebates to Manufacturers for Pharmacy and Physician-Administered Drugs A-04-21-08090
09-18-2023
New York Did Not Ensure That a Managed Care Organization Complied With Requirements for Denying Prior Authorization Requests A-02-21-01016
09-13-2023
Amerigroup Iowa's Prior Authorization and Appeal Processes Were Effective, but Improvements Can Be Made A-07-22-07007
09-12-2023
Novitas Solutions, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals A-07-23-00633
Kentucky Did Not Always Invoice Manufacturers for Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-04-22-07102
09-11-2023
Texas Made Capitation Payments for Enrollees Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Another State A-05-22-00018
Puerto Rico Claimed Over $7 Million in Federal Reimbursement for Medicaid Capitation Payments Made on Behalf of Enrollees Who Were or May Have Been Deceased A-02-21-01005
09-08-2023
Puerto Rico Claimed More Than $500 Thousand in Unallowable Medicaid Managed Care Payments for Enrollees Assigned More Than One Identification Number A-02-21-01004
Medicare Improperly Paid Acute-Care Hospitals for Inpatient Claims Subject to the Post-Acute-Care Transfer Policy Over a 4-Year Period, but CMS's System Edits Were Effective in Reducing Improper Payments by the End of the Period A-09-23-03016
09-07-2023
Georgia Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control A-04-22-08093
08-31-2023
Florida Did Not Refund $106 Million Federal Share of Medicaid Managed Care Rebates It Received for Calendar Years 2015 Through 2020 A-04-22-04089
08-17-2023
Medicare Made $17.8 Million in Potentially Improper Payments for Opioid-Use-Disorder Treatment Services Furnished by Opioid Treatment Programs A-09-22-03005
08-09-2023
Medicare Paid Independent Organ Procurement Organizations Over Half a Million Dollars for Professional and Public Education Overhead Costs That Did Not Meet Medicare Requirements A-09-21-03020
Office of Inspector General's Partnership With the Commonwealth of Massachusetts Office of the State Auditor: Office of Medicaid (MassHealth)-Review of Capitation Payments A-01-22-00002
States With Separate Children's Health Insurance Programs Could Have Collected an Estimated $641 Million Annually If States Were Required To Obtain Rebates Through the Medicaid Drug Rebate Program A-07-22-06106
08-08-2023
Texas Inappropriately Claimed Nearly $1.8 Million in Federal Medicaid Funds for Private Medicaid Management Information System Contractor Costs A-06-19-09003
08-03-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Presbyterian Health Plan, Inc. (Contract H3204) Submitted to CMS A-07-20-01197
08-02-2023
First Coast Service Options, Inc., Did Not Claim Some Allowable Medicare Postretirement Benefit Costs A-07-23-00630
First Coast Service Options, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals A-07-23-00632
First Coast Service Options, Inc., Overstated Its Medicare Segment Postretirement Benefit Assets as of January 1, 2019 A-07-23-00629
First Coast Service Options, Inc., Did Not Claim Some Allowable Medicare Supplemental Executive Retirement Plan Costs A-07-22-00626
08-01-2023
Telehealth During 2020 Helped Ensure End-Stage Renal Disease Patients Received Care, But Limited Information Related to Telehealth Was Documented A-05-22-00015
07-31-2023
New York Improved Its Monitoring of Medicaid Community Rehabilitation Services But Still Claimed Improper Federal Medicaid Reimbursement Totaling $20 Million A-02-22-01011
Medicare Paid $30 Million for Accumulated Repair Costs That Exceeded the Federally Recommended Cost Limit for Wheelchairs During Their 5-Year Reasonable Useful Lifetime A-09-22-03003
07-19-2023
Virginia Made Capitation Payments to Medicaid Managed Care Organizations After Enrollees' Deaths A-03-22-00203
07-10-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Excellus Health Plan, Inc. (Contract H3351) Submitted to CMS A-07-20-01202
06-27-2023
Noridian Healthcare Solutions, LLC, Made $8.8 Million in Improper Monthly Capitation Payments to Physicians and Qualified Nonphysician Practitioners in Jurisdiction E for Certain Services Related to End-Stage Renal Disease A-09-21-03016
06-21-2023
CMS's Oversight of Medicare Payments for the Highest Paid Molecular Pathology Genetic Test Was Not Adequate To Reduce the Risk of up to $888 Million in Improper Payments A-09-22-03010
05-31-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Keystone Health Plan East, Inc. (Contract H3952) Submitted to CMS A-03-20-00001
05-30-2023
Medicare Paid Millions More for Physician Services at Higher Nonfacility Rates Rather Than at Lower Facility Rates While Enrollees Were Inpatients of Facilities A-04-21-04084
05-25-2023
Maryland MMIS and E&E System Security Controls Were Partially Effective and Improvements Are Needed A-18-21-09003
05-24-2023
The Centers for Medicare & Medicaid Services Should Improve Preventative and Detective Controls To More Effectively Mitigate the Risk of Compromise A-18-20-08001
05-17-2023
Montana Generally Complied With Requirements for Telehealth Services During the COVID-19 Pandemic A-07-21-03250
05-16-2023
Massachusetts MMIS and E&E System Security Controls Were Generally Effective, but Some Improvements Are Needed A-18-20-08003
05-02-2023
Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency A-09-21-03021
04-24-2023
Medicare Could Have Saved Up To $128 Million Over 5 Years if CMS Had Implemented Controls To Address Duplicate Payments for Services Provided to Individuals With Medicare and Veterans Health Administration Benefits A-09-22-03004
04-10-2023
CMS Did Not Accurately Report on Care Compare One or More Deficiencies Related to Health, Fire Safety, and Emergency Preparedness for an Estimated Two-Thirds of Nursing Homes A-09-20-02007
04-04-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract H6609) Submitted to CMS A-05-19-00013
03-28-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cigna-HealthSpring Life & Health Insurance Company, Inc. (Contract H4513) Submitted to CMS A-07-19-01192
03-24-2023
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That MCS Advantage, Inc. (Contract H5577) Submitted to CMS A-02-20-01008
03-22-2023
Medicare Improperly Paid Physicians an Estimated $30 Million for Spinal Facet-Joint Interventions A-09-22-03006
03-21-2023
Missouri's Oversight of Certified Individualized Supported Living Provider Health and Safety Could Be Improved in Some Areas A-07-21-03247
03-16-2023
The District of Columbia Has Taken Significant Steps To Ensure Accountability Over Amounts Managed Care Organizations Paid to Pharmacy Benefit Managers A-03-20-00200
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Geisinger Health Plan (Contract H3954) Submitted to CMS A-09-21-03011
03-14-2023
Georgia Did Not Comply With Federal Waiver and State Requirements at All 20 Adult Day Health Care Facilities Reviewed A-04-22-00134
03-13-2023
Georgia Did Not Always Invoice Rebates to Manufacturers for Pharmacy and Physician-Administered Drugs A-04-21-08089
03-10-2023
Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions A-07-21-00618
03-09-2023
Michigan MMIS and E&E Systems Security Controls Were Generally Effective, but Some Improvements Are Needed A-18-20-08004
03-08-2023
Texas Could Not Support the Permissibility of the Funds Used as the State Share of the Medicaid Delivery System Reform Incentive Payment Program A-06-17-09004
03-03-2023
Florida Did Not Invoice Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-04-21-07098
02-28-2023
Medicare Part D Plan Sponsors and CMS Did Not Ensure That Transmucosal Immediate-Release Fentanyl Drugs Were Dispensed Only to Beneficiaries Who Had a Cancer Diagnosis A-09-20-03033
02-27-2023
Medicare Could Have Saved up to $216 Million Over 5 Years if Program Safeguards Had Prevented At-Risk Payments for Definitive Drug Testing Services A-09-21-03006
02-23-2023
Missouri Claimed Federal Medicaid Reimbursement for Tens of Millions in Consumer-Directed Personal Care Assistance Services That Did Not Comply With Federal and State Requirements A-07-20-03243
02-16-2023
Florida Made Capitation Payments for Enrollees Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Another State A-05-21-00028
02-07-2023
North Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-07002
01-05-2023
National Government Services, Inc., Overstated Its Plan B Medicare Segment Pension Assets and Overstated Medicare's Share of the Medicare Segment Excess Pension Assets as of December 31, 2018 A-07-22-00621
National Government Services, Inc., Understated Its Plan A Medicare Segment Pension Assets and Overstated Medicare's Share of the Medicare Segment Excess Pension Liabilities as of December 31, 2018 A-07-22-00620
01-06-2023
National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-22-00623
National Government Services, Inc., Overstated Its United Government Services, LLC, Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Excess Pension Liabilities as of December 31, 2018 A-07-22-00622

2022

12-22-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cigna-HealthSpring of Tennessee, Inc. (Contract H4454) Submitted to CMS A-07-19-01193
12-21-2022
Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19 A-05-21-00035
National Government Services, Inc., Claimed Some Unallowable Medicare Postretirement Benefit Plan Costs Through Its Incurred Cost Proposals A-07-22-00624
National Government Services, Inc., Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan Costs Through Its Incurred Cost Proposals A-07-22-00625
National Government Services, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals A-07-22-00628
12-20-2022
Keystone First Should Improve Its Procedures for Reviewing Service Requests That Require Prior Authorization A-03-20-00201
Mandated Analysis of Home Health Service Utilization From January 2016 Through March 2022 A-05-20-00031
12-15-2022
Providers Did Not Always Comply With Federal Requirements When Claiming Medicare Bad Debts A-07-20-02825
12-08-2022
The Centers for Medicare & Medicaid Services' Review Contractor Did Not Document Medicaid Managed Care Payment Review Determinations Made Under the Payment Error Rate Measurement Program A-04-21-09003
11-22-2022
Medicare Improperly Paid Physicians for Co-Surgery and Assistant-at-Surgery Services That Were Billed Without the Appropriate Payment Modifiers A-01-20-00503
Medicare Providers Did Not Always Comply With Federal Requirements When Billing for Advance Care Planning A-06-20-04008
11-18-2022
Puerto Rico MMIS and E&E Systems Security Controls Were Generally Effective, but Some Improvements Are Needed A-18-20-08005
11-17-2022
National Government Services, Inc., Accurately Calculated Hospice Cap Amounts but Did Not Collect All Cap Overpayments A-06-21-08004
The Centers for Medicare & Medicaid Services' Review Contractors Generally Conducted Medicaid Fee-for-Service Claim Reviews for Selected States Under the Payment Error Rate Measurement Program in Accordance with Federal and State Requirements A-04-21-00132
11-16-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That BCBS of Rhode Island (Contract H4152) Submitted to CMS A-01-20-00500
11-10-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That California Physicians' Service, Inc. (Contract H0504) Submitted to CMS A-09-19-03001
11-09-2022
The Number of Beneficiaries Who Received Medicare Part B Clinical Laboratory Tests Decreased During the First 10 Months of the COVID-19 Pandemic A-09-21-03004
Iowa Implemented Most of Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Major Incidents A-07-21-06105
10-27-2022
Mississippi Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-06101
10-26-2022
CMS Can Use OIG Audit Reports To Improve Its Oversight of Hospital Compliance A-04-21-08084
10-25-2022
California Made Almost $16 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Client Index Numbers A-04-21-07097
Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for 70 Percent of the State's Medicaid Fraud Control Unit Cases A-07-21-02834
CMS Generally Ensured That Medicare Part C and Part D Sponsors Did Not Pay Ineligible Providers for Services to Medicare Beneficiaries A-02-20-01027
10-24-2022
Payments Made to Providers Under the COVID-19 Accelerated and Advance Payments Program Were Generally in Compliance with the CARES Act and Other Federal Requirements A-05-20-00053
09-30-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract R5826) Submitted to CMS A-05-19-00039
09-29-2022
Texas Claimed or May Have Claimed More Than $30 Million of $9.89 Billion in Federal Funds for Medicaid Uncompensated Care Payments That Did Not Meet Federal and State Requirements 
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Highmark Senior Health Company (Contract H3916) Submitted to CMS A-03-19-00001
09-28-2022
Medicare Dialysis Services Provider Compliance Audit - Dialysis Clinic, Inc. A-05-20-00010
09-29-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That BlueCross BlueShield of Tennessee, Inc. (Contract H7917) Submitted to CMS A-07-19-01195
09-26-2022
Medicare Advantage Compliance Audit of Diagnosis Codes That Inter Valley Health Plan, Inc. (Contract H0545), Submitted to CMS A-05-18-00020
09-23-2022
Medicare Hospice Provider Compliance Audit: Hospice of Palm Beach County, Inc. A-02-20-01001
09-22-2022
CMS's System Edits Significantly Reduced Improper Payments to Acute-Care Hospitals After May 2019 for Outpatient Services Provided to Beneficiaries Who Were Inpatients of Other Facilities A-09-22-03007
09-21-2022
End-Stage Renal Disease Network Organizations' Reported Actions Taken in Response to the COVID-19 Pandemic A-05-20-00051
09-20-2022
New York Generally Determined Eligibility for Its Basic Health Program Enrollees in Accordance With Program Requirements A-02-20-01028
09-19-2022
Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States A-05-20-00025
Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services A-06-21-05003
09-15-2022
Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00004
09-14-2022
Tennessee Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-21-06096
09-13-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Regence BlueCross BlueShield of Oregon (Contract H3817) Submitted to CMS A-09-20-03009
09-12-2022
New York Claimed $196 Million, Over 72 Percent of the Audited Amount, in Federal Reimbursement for NEMT Payments to New York City Transportation Providers That Did Not Meet or May Not Have Met Medicaid Requirements A-02-21-01001
08-29-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That WellCare of Florida, Inc., (Contract H1032) Submitted to CMS A-04-19-07084
08-26-2022
Montana Claimed Federal Medicaid Reimbursement for More Than $5 Million in Targeted Case Management Services That Did Not Comply With Federal and State Requirements A-07-21-03246
08-19-2022
Medicare Advantage Compliance Audit of Diagnosis Codes That Cigna HealthSpring of Florida, Inc. (Contract H5410) Submitted to CMS A-03-18-00002
08-10-2022
South Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-07003
07-27-2022
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2021 A-18-22-11300
07-26-2022
Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00005
07-25-2022
CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits A-04-18-03085
07-19-2022
Medicare Critical Care Services Provider Compliance Audit: Lahey Clinic, Inc. A-03-20-00002
07-18-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cariten Health Plan, Inc., (Contract H4461) Submitted to CMS A-02-20-01009
07-15-2022
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
07-14-2022
Medicare Hospice Provider Compliance Audit: Vitas Healthcare Corporation of Florida A-02-19-01018
07-05-2022
The Reduced Outlier Threshold Applied to Transfer Claims Did Not Significantly Increase Medicare Payments to Hospitals A-05-19-00019
06-29-2022
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
06-23-2022
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
06-10-2022
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
06-06-2022
Maine Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00007
05-25-2022
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
Vanderbilt University Medical Center: Audit of Outpatient Outlier Payments A-06-20-04003
05-31-2022
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
05-24-2022
Selected Dialysis Companies Implemented Additional Infection Control Policies and Procedures To Protect Beneficiaries and Employees During the COVID-19 Pandemic A-05-20-00052
05-13-2022
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
04-25-2022
Massachusetts Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00003
04-20-2022
California Improperly Claimed at Least $23 Million of $260 Million in Total Medicaid Reimbursement for Opioid Treatment Program Services A-09-20-02009
04-07-2022
Posthospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries in Indiana Generally Met Medicare Level-of-Care Requirements A-05-20-00005
04-01-2022
South Carolina Did Not Fully Comply With Requirements for Reporting and Monitoring Critical Events Involving Medicaid Beneficiaries With Developmental Disabilities A-04-18-07078
03-29-2022
Psychotherapy Services Billed by a New York City Provider Did Not Comply With Medicare Requirements A-02-21-01006
03-14-2022
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
03-08-2022
New Jersey's Medicaid School-Based Cost Settlement Process Could Result in Claims That Do Not Meet Federal Requirements A-02-20-01012
03-02-2022
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
02-22-2022
Hospitals Did Not Always Meet Differing Medicare Contractor Specifications for Bariatric Surgery A-09-20-03007
02-18-2022
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
02-15-2022
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
02-14-2022
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
02-03-2022
Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan (Contract H5425) Submitted to CMS A-07-17-01169
02-01-2022
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
01-24-2022
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
01-05-2022
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Healthfirst Health Plan, Inc., (Contract H3359) Submitted to CMS A-02-18-01029
01-04-2022
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
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

2021

12-22-2021
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
12-16-2021
Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern A-09-20-03027
Medicare Hospital Provider Compliance Audit: St. Joseph's Hospital Health Center A-02-20-01004
12-07-2021
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-01-20-00501
12-03-2021
Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation Sessions A-09-21-03002
12-02-2021
Kentucky Made Almost $2 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Medicaid ID Numbers A-04-20-07094
11-22-2021
CMS Should Strengthen Its Prescription Drug Event Guidance To Clarify Reporting of Sponsor Margin for Medicare Part D Bids A-03-17-00001
11-17-2021
Missouri Properly Converted Provisionally Enrolled Medicaid Providers to Permanent Providers A-07-21-03248
11-16-2021
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
11-05-2021
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UPMC Health Plan, Inc. (Contract H3907) Submitted to CMS A-07-19-01188
10-28-2021
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health Care of Missouri, Inc. (Contract H2663) Submitted to CMS A-07-17-01173
10-25-2021
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 Members A-01-20-00001
10-21-2021
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
10-19-2021
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
10-13-2021
Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic A-06-20-04007
10-01-2021
Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries A-01-18-00500
09-24-2021
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, Caregivers, and Staff During the COVID-19 Pandemic A-01-20-00508
09-22-2021
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
09-21-2021
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
09-20-2021
Minnesota Medicaid Managed Care Entities Used a Majority of Medicaid Funds Received for Medical Expenses and Quality Improvement Activities A-05-18-00018
09-08-2021
Colorado Did Not Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-17-06075
09-07-2021
An Ophthalmology Clinic in Florida: Audit of Medicare Payments for Eye Injections of Avastin, Eylea, and Lucentis A-09-19-03025
09-01-2021
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
Kansas Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-07-20-05125
08-25-2021
CGS Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00613
CMS Needs To Issue Regulations Related to Phlebotomy Travel Allowances A-06-20-04000
CGS Administrators, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00612
08-18-2021
Medicare Home Health Agency Provider Compliance Audit: Catholic Home Care A-02-19-01013
Medicare Hospital Provider Compliance Audit: Jewish Hospital A-04-19-08077
CGS Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00593
CGS Administrators, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00608
08-13-2021
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
08-12-2021
Oklahoma's Oversight of Medicaid Outpatient Services for Opioid Use Disorder Was Generally Effective A-06-20-08000
Missouri Claimed Federal Reimbursement for $3.4 Million in Payments to Health Home Providers That Did Not Meet Medicaid Requirements A-07-20-04117
08-10-2021
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00616
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00615
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
Companion Data Services, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00610
Companion Data Services, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00609
Palmetto Government Benefits Administrator, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00592
08-06-2021
Almost All of the Medicare Pension Costs That Companion Data Services, LLC, Claimed Through Its Incurred Cost Proposals Were Allowable A-07-20-00594
Medicare Continues To Make Overpayments for Chronic Care Management Services, Costing the Program and Its Beneficiaries Millions of Dollars A-07-19-05122
07-28-2021
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 in Federal Medicaid Funds A-06-18-09002
07-21-2021
Texas Made Unallowable Children's Health Insurance Program Payments for Beneficiaries Assigned More Than One Identification Number A-06-20-10003
07-20-2021
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
07-12-2021
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2020 A-18-21-11300
Audit of Medicare Part D Pharmacy Fees: Group Health Cooperative, Inc. A-03-19-00002
Medicare Hospice Provider Compliance Audit: Partners In Care, Inc. A-09-18-03024
07-08-2021
Medicare Hospice Provider Compliance Audit: Mission Hospice & Home Care, Inc. A-09-18-03009
The Centers for Medicare & Medicaid Services Did Not Account for National Security Risks in Its Enterprise Risk Management Processes A-18-20-06200
07-07-2021
Medicare Payments for Transitional Care Management Services Generally Complied With Federal Requirements, but Some Overpayments Were Made A-07-17-05100
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 Requirements But It Still Made $6 Million in Improper Payments to Some Providers A-02-19-01007
06-30-2021
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
Medicare Hospital Provider Compliance Audit: Lake Hospital System A-05-19-00024
06-24-2021
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 Hospitals A-02-21-01003
Medicare Hospital Provider Compliance Audit: Staten Island University Hospital A-02-18-01025
Kentucky Claimed Millions in Unallowable School-Based Medicaid Administrative Costs A-04-17-00113
06-23-2021
Medicare Hospice Provider Compliance Audit: Northwest Hospice, LLC A-09-20-03035
06-10-2021
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
Medicare Hospice Provider Compliance Audit: Professional Healthcare at Home, LLC A-09-18-03028
06-09-2021
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
06-08-2021
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
06-03-2021
University of Michigan Health System: Audit of Medicare Payments for Polysomnography Services A-04-20-07088
06-02-2021
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
05-28-2021
Medicare Home Health Agency Provider Compliance Audit: Caretenders of Jacksonville, LLC A-04-16-06195
05-25-2021
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
05-24-2021
Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments A-07-19-05117
05-21-2021
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS A-07-19-01187
05-20-2021
Sleep Management, LLC: Audit of Claims for Monthly Rental of Noninvasive Home Ventilators A-04-18-04066
05-18-2021
Medicare Hospice Provider Compliance Audit: Franciscan Hospice A-09-20-03034
05-14-2021
Medicare Hospice Provider Compliance Audit: Alive Hospice, Inc. A-09-18-03016
Medicare Hospice Provider Compliance Audit: Ambercare Hospice, Inc. A-09-18-03017
05-13-2021
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
05-11-2021
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
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
05-07-2021
Medicare Hospice Provider Compliance Audit: Suncoast Hospice A-02-18-01001
05-06-2021
Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00032
05-05-2021
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
05-04-2021
Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital A-02-18-01018
04-27-2021
Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Maryland A-03-17-00009
04-21-2021
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
04-19-2021
Medicare Advantage Compliance Audit of Diagnosis Codes That Humana, Inc., (Contract H1036) Submitted to CMS A-07-16-01165
04-12-2021
Georgia Generally Ensured That Nursing Facilities Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Prioritized Allegations Timely A-04-17-03084
04-08-2021
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
04-08-2021
Palmetto Government Benefits Administrator, LLC, Overstated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00598
04-07-2021
Noridian Healthcare Solutions, LLC, Claimed Unallowable Medicare Nonqualified Restoration Savings Plan Costs Through Its Incurred Cost Proposals A-07-20-00591
03-31-2021
Medicare Hospital Provider Compliance Audit: Sunrise Hospital & Medical Center A-04-19-08075
03-29-2021
Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds A-06-19-02000
03-23-2021
Companion Data Services, LLC, Properly Updated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-21-00606
03-29-2021
An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis A-09-19-03022
03-17-2021
North Mississippi Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07086
03-04-2021
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 Incidents A-04-17-08058
03-01-2021
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
02-25-2021
Medicare Home Health Agency Provider Compliance Audit: Brookdale Home Health, LLC A-04-18-06221
02-24-2021
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross Blue Shield of Michigan (Contract H9572) Submitted to CMS A-02-18-01028
02-22-2021
Medicare Hospice Provider Compliance Audit: Tidewell Hospice, Inc. A-02-18-01024
02-19-2021
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
02-16-2021
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
Iowa Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-19-03238
02-03-2021
Illinois Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00031
01-27-2021
Louisiana Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-06-18-02000
01-25-2021
California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider's Opioid Treatment Program Services A-09-20-02001
01-21-2021
Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program A-01-19-00004
01-15-2021
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
01-13-2021
Medicare Home Health Agency Provider Compliance Audit: Southeastern Home Health Services A-03-17-00004

2020

12-30-2020
The Centers for Medicare & Medicaid Services Could Improve Its Wage Index Adjustment for Hospitals in Areas With the Lowest Wages 
12-22-2020
Medicare Home Health Agency Provider Compliance Audit: Tender Touch Health Care Services A-04-18-07077
12-21-2020
Aspects of Texas' Quality Incentive Payment Program Raise Questions About Its Ability To Promote Economy and Efficiency in the Medicaid Program A-06-18-07001
12-16-2020
Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Tullahoma, Tennessee A-02-16-01024
12-16-2020
Medicare Hospital Provider Compliance Audit: Providence Medical Center A-07-18-05113
12-11-2020
Risk Assessment Puerto Rico Medicaid Program A-02-20-01011
12-09-2020
New York Improved Its Monitoring of Its Personal Care Services Program But Still Made Improper Medicaid Payments of More Than $54 Million A-02-19-01016
12-07-2020
Medicare Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC A-06-16-05005
12-01-2020
Nebraska Claimed Almost All Medicaid Payments for Targeted Case Management Services in Accordance With Federal Requirements but Claimed Some Unallowable Duplicate Payments A-07-19-03239
11-24-2020
Florida Received Unallowable Medicaid Reimbursement for School-Based Services A-04-18-07075
11-19-2020
Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Payson, Arizona. A-02-16-01023
11-18-2020
Medicare Home Health Agency Provider Compliance Audit: The Palace at Home A-04-17-07067
11-17-2020
Cahaba Government Benefits Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00577
Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00578
11-16-2020
Hospitals Did Not Comply With Medicare Requirements for Reporting Cardiac Device Credits A-01-18-00502
11-12-2020
Ohio Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00023
Medicare Hospital Provider Compliance Audit: Edward W. Sparrow Hospital A-05-18-00045
11-10-2020
Ohio Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-05-18-00027
11-05-2020
Cahaba Government Benefits Administrators, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00575
Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00576
11-04-2020
CMS Did Not Ensure That Medicare Hospital Payments for Claims That Included Medical Device Credits Were Reduced in Accordance With Federal Regulations, Resulting in as Much as $35 Million in Overpayments A-07-19-00560
10-29-2020
Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc. A-02-17-01025
10-22-2020
Massachusetts Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-06-18-04001
10-21-2020
Minnesota Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00018
10-16-2020
Medicare Home Health Agency Provider Compliance Audit: Gem City Home Care, LLC A-05-18-00011
Medicare Hospital Provider Compliance Audit: St Francis Hospital A-05-18-00048
10-14-2020
Cedars-Sinai Medical Center: Audit of Medicare Payments for Bariatric Surgeries A-09-18-03010
10-09-2020
Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period A-09-20-03003
10-07-2020
Update on Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic A-09-20-01000
10-02-2020
Colorado Improperly Claimed Millions in Enhanced Federal Medicaid Reimbursement for New Adult Group Beneficiaries Because of a Data Processing Error A-07-17-02807
Medicare Critical Care Services Provider Compliance Audit: Clinical Practices of the University of Pennsylvania A-03-18-00003
09-30-2020
Medicare Hospital Provider Compliance Audit: Alta Bates Summit Medical Center A-04-19-08071
09-25-2020
North Carolina Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-04-16-00112
09-22-2020
Oregon's Oversight Did Not Ensure That Four Coordinated-Care Organizations Complied With Selected Medicaid Requirements Related to Access to Care and Quality of Care A-09-18-03035
CMS's Monitoring Activities for Ensuring That Medicare Accountable Care Organizations Report Complete and Accurate Data on Quality Measures Were Generally Effective, but There Were Weaknesses That Could Be Improved A-09-18-03033
09-21-2020
Connecticut Did Not Meet Federal and State Requirements for Claiming Medicaid School-Based Child Health Services for Hartford Public Schools A-01-19-00003
09-18-2020
North Carolina Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-19-08070
Vermont Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-19-06086
09-17-2020
Illinois Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-05-18-00037
09-16-2020
Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations A-07-17-01176
Medicare-Allowed Charges for Noninvasive Ventilators Are Substantially Higher Than Payment Rates of Select Non-Medicare Payers A-05-20-00008
Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals A-07-20-00590
09-14-2020
Maine Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-18-06079
09-11-2020
Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services A-05-18-00035
Group Health Incorporated Overstated Its Allowable Medicare Supplemental Executive Retirement Plan Costs for Calendar Years 2009 Through 2016 A-07-19-00582
Group Health Incorporated Claimed Some Unallowable Medicare Postretirement Benefit Costs for Calendar Years 2009 Through 2016  A-07-19-00583
Group Health Incorporated Overstated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of December 31, 2015 A-07-19-00579
Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of August 31, 2016 A-07-19-00580
Group Health Incorporated Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2009 Through 2016 A-07-19-00581
09-08-2020
Indiana Did Not Ensure That Medicaid Payments Were Made Properly for Some Claims Identified as Having Third-Party Coverage A-05-18-00046
09-04-2020
Audit of Medicare Part D Pharmacy Fees: Horizon Blue Cross Blue Shield, Inc. A-03-18-00007
09-03-2020
Baylor Scott & White—College Station: Audit of Outpatient Outlier Payments A-06-18-04003
09-01-2020
Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group A-07-19-02822
Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center A-07-18-05112
08-27-2020
Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program A-06-17-09002
08-25-2020
Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00017
Illinois Claimed Unallowable Telemedicine Payments  A-05-18-00028
Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements A-05-18-00043
Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process A-05-18-00024
08-21-2020
CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete A-05-16-00051
08-19-2020
New Jersey Did Not Ensure That Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries Residing in Nursing Facilities Were Always Properly Investigated and Reported  A-02-18-01006
08-18-2020
Indiana Properly Reported Adjustments Related to the Drug Rebate Program A-05-19-00028
08-14-2020
Nebraska Claimed Unallowable School-Based Administrative Costs Because of Improper Coding of Random Moment Timestudy Responses A-07-19-03234
08-11-2020
Medicare Home Health Agency Provider Compliance Audit: Mission Home Health of San Diego, Inc.  A-09-18-03008
08-10-2020
Visionquest Industries, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03010
Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc. A-02-17-01022
08-06-2020
Desoto Home Health Care, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03021
08-05-2020
Inadequate Edits and Oversight Caused Medicare To Overpay More Than $267 Million for Hospital Inpatient Claims With Post-Acute-Care Transfers to Home Health Services A-04-18-04067
08-04-2020
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2019 A-18-20-11300
07-29-2020
North Carolina Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse and Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Timely A-04-17-04063
07-27-2020
The New York State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-04-19-06223
07-24-2020
Factsheet: Ohio's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-05-19-00036
07-22-2020
CMS Could Have Saved $192 Million by Targeting Home Health Claims for Review With Visits Slightly Above the Threshold That Triggers a Higher Medicare Payment A-09-18-03031
07-21-2020
On-Site Psychological Services, P.C.: Audit of Medicare Payments for Psychotherapy Services A-02-19-01012
Alaska Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-09-19-02001
07-15-2020
CMS Did Not Administer and Manage Strategic Communications Services Contracts in Accordance With Federal Requirements A-12-19-20003
07-13-2020
Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims A-03-17-00010
07-10-2020
Medicaid Data Can Be Used To Identify Instances of Potential Child Abuse or Neglect  A-01-19-00001
07-09-2020
Texas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-04003
07-06-2020
Freedom Orthotics, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03012
06-03-2020
Texas Telemedicine Services Were Provided in Accordance with State Requirements A-06-18-05001
06-01-2020
New Jersey Did Not Ensure That Its Managed Care Organizations Adequately Assessed and Covered Medicaid Beneficiaries' Needs for Long-Term Services and Supports A-02-17-01018
05-22-2020
Medicare Hospital Provider Compliance Audit: The Ohio State University Hospital A-05-18-00042
05-01-2020
Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays A-01-17-00508
04-29-2020
North Carolina Received $30 Million in Excess Federal Funds Related to Improperly Claimed Health Home Expenditures A-04-18-00120
04-20-2020
Grand Desert Psychiatric Services: Audit of Medicare Payments for Psychotherapy Services A-09-19-03018
04-17-2020
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-20-00589
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Pension Costs A-07-20-00588
Companion Data Services, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00587
Palmetto Government Benefits Administrator, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00586
04-16-2020
Recommendation Followup: Michigan Did Not Report and Refund the Full Federal Share of Medicaid Overpayments A-05-18-00022
04-09-2020
Medicare Home Health Agency Provider Compliance Audit: Residential Home Health A-05-16-00063
An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare's Medical Necessity or Documentation Requirements A-01-16-00508
04-07-2020
New York Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-02-18-01016
Iowa Inadequately Monitored Its Medicaid Health Home Providers, Resulting in Tens of Millions in Improperly Claimed Reimbursement A-07-18-04109
04-01-2020
96 Percent of South Carolina's Medicaid Fee-for-Service Telemedicine Payments Were Insufficiently Documented or Otherwise Unallowable A-04-18-00122
03-27-2020
Medicare Hospital Provider Compliance Audit: Forbes Hospital A-03-18-00005
Iowa Did Not Comply With Federal and State Requirements for Major Incidents Involving Medicaid Members With Developmental Disabilities A-07-18-06081
03-26-2020
New York's Oversight of Medicaid Managed Care Organizations Did Not Ensure Providers Complied With Health and Safety Requirements at 18 of 20 Adult Day Care Facilities Reviewed A-02-18-01027
03-25-2020
Medicare Dialysis Services Provider Compliance Review: Bio-Medical Applications of Arecibo, Inc. A-02-17-01016
03-24-2020
Most of the Non-Newly Eligible Beneficiaries for Whom Colorado Made Medicaid Payments Met Federal and State Requirements, but Documentation Supporting That All Eligibility Requirements Were Verified Properly Was Not Always in Place A-07-18-02812
03-23-2020
Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers A-04-18-07080
03-17-2020
CMS Could Take Actions To Help States Comply With Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions  A-09-18-02004
03-13-2020
Missouri Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-18-03230
03-06-2020
Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-18-08065
03-03-2020
Factsheet: Kentucky's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-02022
03-02-2020
Medicare Hospital Provider Compliance Audit: Saint Francis Health Center A-07-17-05102
02-28-2020
The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act A-03-16-03001
02-25-2020
CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments A-06-16-01002
02-20-2020
New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers A-02-18-01020
02-19-2020
New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-02-18-01011
02-14-2020
Michigan Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-05-17-00048
02-11-2020
The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes A-05-17-00020
02-07-2020
The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs A-09-18-01000
02-06-2020
New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option A-02-17-01015
02-06-2020
Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes A-06-19-08001
02-04-2020
New York Claimed Tens of Millions of Dollars for Opioid Treatment Program Services That Did Not Comply With Medicaid Requirements Intended To Ensure the Quality of Care Provided to Beneficiaries A-02-17-01021
01-29-2020
The Indiana State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-05-19-00007
01-24-2020
More Than One-Third of New Jersey's Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable A-02-17-01020
01-21-2020
CMS's Implementation of a 2014 Policy Change Resulted in Improvements in the Reporting of Coverage Gap Discounts Under Medicare Part D A-07-16-06067
01-17-2020
Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-03-17-00202
01-13-2020
CMS's Controls Over Assigning Medicare Beneficiary Identifiers and Mailing New Medicare Cards Were Generally Effective but Could Be Improved in Some Areas A-09-19-03003
01-09-2020
New York Improperly Claimed Medicaid Reimbursement for Some Bridges to Health Waiver Program Services That Were Not in Accordance With an Approved Plan of Care and Did Not Meet Documentation Requirements A-02-18-01003

2019

12-16-2019
Novitas Solutions, Inc. Needs Enhanced Guidance and Provider Education Related to Phlebotomy Travel Allowances  A-06-17-04002
12-12-2019
CMS Made an Estimated $93.6 Million in Incorrect Medicare Electronic Health Record Incentive Payments to Acute-Care Hospitals, or Less Than 1 Percent of $10.8 Billion in Total Incentive Payments A-09-18-03020
12-10-2019
Medicare Hospital Provider Compliance Audit: Texas Health Presbyterian Hospital Dallas  A-04-18-08068
12-05-2019
Medicare Home Health Agency Provider Compliance Audit: Palos Community Hospital Home Health Agency A-05-17-00022
11-27-2019
Medicare Hospital Provider Compliance Audit: St. Vincent Hospital A-05-18-00040
Factsheet: Alabama's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-00125
11-26-2019
Medicare Hospital Provider Compliance Audit: Northwest Medical Center A-04-18-08064
Medicare Hospital Provider Compliance Audit: Carolinas Hospital A-04-18-08063
11-22-2019
Hospitals Received Millions in Excessive Outlier Payments Because CMS Limits the Reconciliation Process A-05-16-00060
11-21-2019
Noridian Healthcare Solutions, LLC, Did Not Claim Allowable Medicare Nonqualified Costs A-07-19-00574
Noridian Healthcare Solutions, LLC, Did Not Claim Allowable Medicare Nonqualified Costs Through Its Incurred Cost Proposals A-07-19-00573
11-20-2019
Cahaba Safeguard Administrators, LLC, Properly Updated the Medicare Segment Pension Assets as of January 1, 2017 A-07-19-00571
Cahaba Government Benefits Administrators, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-19-00570
11-18-2019
Registered Nurses Did Not Always Visit Medicare Beneficiaries' Homes At Least Once Every 14 Days To Assess The Quality of Care and Services Provided by Hospice Aides A-09-18-03022
11-13-2019
California Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-09-18-02009
11-12-2019
Highlands of Little Rock West Markham Holdings, LLC: Audit of Documentation of Therapy Resource Utilization Groups A-06-18-08003
11-08-2019
New Jersey Improperly Claimed Tens of Millions for Medicaid School-Based Administrative Costs Based on Random Moment Sampling That Did Not Meet Federal Requirements A-02-17-01006
11-07-2019
The University of Minnesota Complied With Federal Requirements To Perform Risk Assessments and Monitor Subrecipients A-05-18-00015
Medicare Made Hundreds of Thousands of Dollars in Overpayments for Chronic Care Management Services A-07-17-05101
11-06-2019
Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-19-00569
Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00568
Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Postretirement Benefit Assets A-07-19-00567
Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-18-00550
Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Pension Costs A-07-18-00548
Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Pension Assets A-07-18-00547
11-01-2019
Medicare Improperly Paid Acute-Care Hospitals $54.4 Million for Inpatient Claims Subject to the Post-Acute-Care Transfer Policy A-09-19-03007
10-31-2019
Audit of Medicare Part D Pharmacy Fees: Geisinger Health Systems, Inc. A-03-18-00006
Medicare Improperly Paid Suppliers an Estimated $92.5 Million for Inhalation Drugs A-09-18-03018
10-30-2019
Medicare Allowable Amounts for Certain Orthotic Devices Are Not Comparable With Payments Made by Select Non-Medicare Payers A-05-17-00033
Medicare Home Health Agency Provider Compliance Review: Angels Care Home Health A-07-16-05093
10-29-2019
Tennessee Made Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid Identification Numbers A-04-18-07079
10-23-2019
The Centers for Medicare & Medicaid Services Could Improve Its Processes for Evaluating and Reporting Payment Recovery Savings Associated With the Fraud Prevention System A-01-15-00510
10-21-2019
Texas Did Not Ensure That Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-06-16-01001)
Rhode Island Hospital Submitted Some Inaccurate Wage Data A-01-17-00509
Sunshine ACO, LLC, Generally Reported Complete and Accurate Data on Quality Measures Through the CMS Web Portal, but There Were a Few Reporting Deficiencies That Did Not Affect the Overall Quality Performance Score (A-09-18-03019)
10-01-2019
The Minnesota State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths (A-05-17-00049)
09-30-2019
Wisconsin Physicians Service Needs Enhanced Guidance and Provider Education Related to Phlebotomy Travel Allowances (A-06-17-04005)
California Needs To Improve Oversight of Community-Based Adult Services Providers' Compliance With Health and Safety and Administrative Requirements (A-09-18-02002)
09-26-2019
National Government Services, Inc., Did Not Claim Some Medicare Postretirement Benefit Plan Costs Through Its Incurred Cost Proposals (A-07-19-00566)
National Government Services, Inc., Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals  (A-07-19-00572)
National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals (A-07-19-00564)
National Government Services, Inc., Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan Costs Through Its Incurred Cost Proposals (A-07-19-00565)
09-24-2019
National Government Services, Inc., Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Final Administrative Cost Proposals (A-07-19-00563)
National Government Services, Inc., Claimed Some Unallowable Supplemental Executive Retirement Plan Costs Through Its Final Administrative Cost Proposals (A-07-18-00551)
09-19-2019
CMS Paid Over $277 Million in Unallowable CHIPRA Bonus Payments Based on Incorrect Enrollment Data (A-04-17-08061)
09-12-2019
Ohio Made Medicaid Capitation Payments That Were Duplicative or Were Improper Based on Beneficiary Eligibility Status or Demographics (A-05-16-00061)
09-11-2019
Medicare Incorrectly Paid Providers for Emergency Ambulance Transports From Hospitals to Skilled Nursing Facilities  (A-09-18-03030)
09-05-2019
The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home Health Agencies  (A-05-17-00035)
08-30-2019
Twin Palms Received Unallowable Medicare Payments for Chiropractic Services (A-04-16-07065)
Colorado Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries (A-07-16-04228)
Florida Medicaid Paid Hundreds of Millions in Unallowable Payments to Jackson Memorial Hospital Under Its Low Income Pool Program (A-04-17-04058)
New Jersey Did Not Bill Manufacturers for Tens of Millions of Dollars in Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-02-16-01011)
08-29-2019
West Florida ACO, LLC, Generally Reported Complete and Accurate Data on Quality Measures Through the CMS Web Portal, but There Were a Few Reporting Deficiencies That Did Not Affect the Overall Quality Performance Score (A-09-18-03003)
08-28-2019
Oceanside Medical Group Received Unallowable Medicare Payments for Psychotherapy Services (A-09-18-03004)
08-22-2019
Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit (A-06-17-08004)
08-21-2019
Texas Did Not Bill Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-06-17-04001)
08-20-2019
Illinois Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths (A-05-18-00026)
Mederi Caretenders Home Health Billed for Home Health Services That Did Not Comply With Medicare Billing Requirements (A-07-16-05092)
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2018 (A-18-19-11300)
New York Incorrectly Claimed Enhanced Federal Medicaid Reimbursement for Some Beneficiaries (A-02-15-01023)
New York Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness (A-02-17-01027)
08-16-2019
Connecticut Claimed Unallowable Federal Reimbursement for Medicaid Physician-Administered Drugs That Were Not Invoiced to Manufacturers for Rebates (A-07-18-06078)
08-09-2019
Georgia Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths (A-04-15-06183)
08-07-2019
Pennsylvania Did Not Ensure That Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-03-16-00205)
07-25-2019
Group Health Incorporated Understated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets as of January 1, 2015 (A-07-19-00561)
Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Pension Assets as of January 1, 2015  (A-07-19-00562)
Group Health Incorporated Understated Its Cash Balance Pension Plan Medicare Segment Pension Assets as of January 1, 2011 (A-07-19-00557)
07-24-2019
Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic (A-09-18-01005)
07-23-2019
A Resource Guide for Using Diagnosis Codes in Health Insurance Claims To Help Identify Unreported Abuse or Neglect  (A-01-19-00502)
07-17-2019
New York Did Not Correctly Determine Medicaid Eligibility for Some Non-Newly Eligible Beneficiaries (A-02-16-01005)
07-09-2019
Kentucky Did Not Comply With Federal Waiver and State Requirements at 14 of 20 Adult Day Health Care Facilities Reviewed  (A-04-18-00123)
07-02-2019
New York's Claims for Medicaid Nursing Home Transition and Diversion Waiver Program Services Generally Complied With Federal and State Requirements but Had Reimbursement Errors That Resulted in a Minimal Amount of Overpayments (A-02-17-01005)
07-01-2019
New York Claimed Federal Reimbursement for Some Payments to Health Home Providers That Did Not Meet Medicaid Requirements (A-02-17-01004)
Medicare Part D Rebates for Prescriptions Filled at 340B Contract Pharmacies (A-03-16-00002)
06-27-2019
Recommendation Followup: Delaware Is Reporting Medicaid Overpayments In Compliance With Federal Requirements (A-03-17-00203)
06-18-2019
Illinois Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-05-18-00030)
06-13-2019
Medicare Could Have Saved Millions of Dollars in Payments for Three-Dimensional Conformal Radiation Therapy Planning Services (A-09-18-03026)
06-12-2019
CMS Could Use Medicare Data To Identify Instances of Potential Abuse or Neglect (A-01-17-00513)
Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated (A-01-16-00509)
Medicare Payments to Providers for Polysomnography Services Did Not Always Meet Medicare Billing Requirements (A-04-17-07069)
06-11-2019
Alaska Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities (A-09-17-02006)
06-04-2019
Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections (A-06-17-02002)
The Therapy Resource Utilization Groups at Epworth Villa Retirement Community's Skilled Nursing Facility Were Properly Supported (A-06-18-08002)
05-30-2019
New York May Not Have Complied With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-02-16-01022)
05-28-2019
Great Lakes Home Health Services, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-05-16-00057)
05-23-2019
St. Joseph's Hospital and Medical Center Submitted Some Inaccurate Wage Data (A-01-17-00510)
05-20-2019
Metropolitan Jewish Home Care, Inc., Billed for Home Health Services That Did Not Comply with Medicare Requirements (A-02-16-01001)
05-16-2019
Four States Did Not Comply With Federal Waiver and State Requirements in Overseeing Adult Day Care Centers and Foster Care Homes (A-05-19-00005)
05-13-2019
EHS Home Health Care Service, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-05-16-00055)
05-09-2019
New Jersey Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-02-16-01012)
05-08-2019
Massachusetts Did Not Ensure Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-01-17-00003)
Excella HomeCare Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-01-16-00500)
05-07-2019
California Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths (A-04-18-06220)
04-30-2019
Some Diagnosis Codes That Essence Healthcare, Inc., Submitted to CMS Did Not Comply With Federal Requirements (A-07-17-01170)
04-29-2019
Medicaid Could Save Hundreds of Millions by Excluding Authorized Generic Drug Transactions to Secondary Manufacturers from Brand Name Drugs� Average Manufacturer Price Calculations (A-06-18-04002)
04-26-2019
Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents (A-09-18-02010)
04-05-2019
Indiana Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-05-17-00038)
03-27-2019
Factsheet: Texas' Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-06-18-04000)
03-25-2019
New Jersey Did Not Provide Adequate Oversight of Its Medicaid Delivery System Reform Incentive Payment Program (A-02-17-01007)
03-05-2019
Factsheet: West Virginia's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-03-18-03302)
Missouri Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services (A-07-17-03219)
02-28-2019
Michigan Disbursed Only Part of Its Civil Money Penalty Collections, Limiting Resources To Protect or Improve Care for Nursing Facility Residents (A-05-17-00019)
02-25-2019
Factsheet: New Hampshire's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-01-18-01501)
02-14-2019
CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met (A-05-16-00043)
Factsheet: Nevada's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-09-18-01004)
02-12-2019
New Mexico Did Not Always Appropriately Refund the Federal Share of Recoveries from Managed Care Organizations (A-06-18-09001)
TrustSolutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals (A-07-18-00540)
02-08-2019
Factsheet: Utah's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-07-18-05115)
02-06-2019
Factsheet: Tennessee's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-04-18-00124)
02-07-2019
CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs To Be Improved To Help Ensure the Health and Safety of Nursing Home Residents (A-09-18-02000)
02-06-2019
Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements (A-01-17-00506)
02-04-2019
Medicare Compliance Review of Community Hospital (A-05-17-00026)
01-31-2019
Factsheet: Nebraska's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-07-18-06080)
01-17-2019
Kelley Medical Equipment and Supply, LLC, Received Unallowable Medicare Payments for Orthotic Braces (A-09-17-03030)
01-15-2019
Although the Centers for Medicare & Medicaid Services Has Made Progress, It Did Not Always Resolve Audit Recommendations in Accordance With Federal Requirements (A-07-18-03228)
01-10-2019
Virginia Received Millions in Unallowable Bonus Payments (A-04-17-08060)
01-04-2019
Rhode Island Did Not Ensure Its Managed Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-01-17-00004)

2018

12-31-2018
A Queens Chiropractor Received Improper Medicare Payments for Chiropractic Services (A-02-15-01003)
Pacific Medical, Inc., Received Some Unallowable Medicare Payments for Orthotic Braces (A-09-17-03027)
12-28-2018
Dialysis Services Provided by Atlantis Health Care Group of Puerto Rico, Inc., Did Not Comply With Medicare Requirements Intended To Ensure the Quality of Care Provided to Medicare Beneficiaries (A-02-16-01009)
12-20-2018
First Coast Service Options, Inc., Paid Providers for Hyperbaric Oxygen Therapy Services That Did Not Comply With Medicare Requirements (A-04-16-06196)
12-19-2018
Midwood Ambulance & Oxygen Service, Inc., Billed for Nonemergency Ambulance Transport Services That Did Not Comply With Medicare Requirements (A-02-16-01021)
12-17-2018
Louisiana Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-06-16-02003)
12-13-2018
Wisconsin Did Not Report and Refund the Full Federal Share of Medicaid-Related Settlements and a Judgment (A-05-17-00041)
12-12-2018
Texas Claimed Community First Choice Fee-for-Service Expenditures Appropriately (A-06-17-08002)
12-11-2018
Factsheet: Washington State's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-09-18-02001)
California Made Medicaid Payments on Behalf of Non-Newly Eligible Beneficiaries Who Did Not Meet Federal and State Requirements (A-09-17-02002)
12-07-2018
The Centers for Medicare & Medicaid Services Had Not Recovered More Than a Billion Dollars in Medicaid Overpayments Identified by OIG Audits (A-05-17-00013)
12-06-2018
Payments Made by National Government Services, Inc., to Hospitals for Certain Advanced Radiation Therapy Services Did Not Fully Comply With Medicare Requirements (A-02-16-01007)
Vulnerabilities Exist in State Agencies' Use of Random Moment Sampling To Allocate Costs for Medicaid School-Based Administrative and Health Services Expenditures (A-07-18-04107)
11-30-2018
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2017 (A-18-18-11300)
11-29-2018
Medicare Improperly Paid Suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Beneficiaries During Inpatient Stays (A-09-17-03035)
11-27-2018
CMS's Enhanced Controls Did Not Always Prevent Terminated Drug Utilization in Medicare Part D (A-07-16-06068)
11-23-2018
New York May Have Improperly Claimed Medicaid Reimbursement for Certain Dental Services (A-02-16-01020)
Summary of Security Vulnerabilities Identified at Two Arizona Managed Care Organizations and Inconsistent Treatment of Medicaid Data Security at the State Agency and Managed Care Organizations (A-18-17-09302)
11-21-2018
Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments (A-01-17-00500)
11-07-2018
National Government Services, Inc., Understated Its Plan A Medicare Segment Pension Assets (A-07-18-00541)
National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs (A-07-18-00543)
National Government Services, Inc., Did Not Claim Some Allowable Medicare Postretirement Benefit Costs (A-07-18-00552)
11-08-2018
Payments Made by Novitas Solutions, Inc., to Hospitals for Certain Advanced Radiation Therapy Services Did Not Fully Comply With Medicare Requirements (A-02-16-01006)
Although Hospital Tax Programs in Seven States Complied With Hold-Harmless Requirements, the Tax Burden on Hospitals Was Significantly Mitigated (A-03-16-00202)
11-01-2018
CMS Did Not Always Ensure Hospitals Complied With Medicare Reimbursement Requirements for Graduate Medical Education (A-02-17-01017)
10-25-2018
New York Claimed Federal Reimbursement for Some Assertive Community Treatment Services That Did Not Meet Medicaid Requirements (A-02-17-01008)
10-24-2018
Professional Clinical Laboratory, Inc., Generally Did Not Comply With Medicare Requirements For Billing Phlebotomy Travel Allowances (A-06-16-02002)
10-18-2018
Medicare Compliance Review of Mobile Infirmary Medical Center (A-04-17-08057)
10-16-2018
United Government Services, LLC, Properly Updated the Medicare Segment Pension Assets as of January 1, 2015 (A-07-18-00538)
TrustSolutions, LLC, Properly Updated the Medicare Segment Pension Assets as of December 31, 2012 (A-07-18-00539)
National Government Services, Inc., Properly Updated the Plan B Medicare Segment Pension Assets as of January 1, 2015 (A-07-18-00542)
10-15-2018
Wisconsin Did not Comply With Federal Waiver and State Requirements at all 20 Adult Day Care Centers Reviewed (A-05-17-00030)
10-04-2018
Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths 
09-27-2018
Wisconsin Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths (A-05-17-00006)
Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements (A-01-15-00500)
09-19-2018
Etheredge Chiropractic Received Unallowable Medicare Payments for Chiropractic Services (A-04-16-07064)
09-11-2018
First Coast Service Options, Inc., Overstated Medicare�s Share of the Medicare Segment Excess Pension Liabilities (A-07-18-00535)
09-06-2018
National Institute of Transplantation, an Independent Histocompatibility Laboratory, Did Not Fully Comply With Medicare�s Cost-Reporting Requirements (A-09-16-02010)
09-04-2018
CMS Enrollment System Needs To Enhance Resiliency (A-18-17-06501)
08-20-2018
Mississippi Did Not Comply With Federal Waiver and State Requirements at All 20 Adult Day Care Facilities Reviewed (A-04-17-00116)
08-17-2018
Liberty Medical, LLC, Received Unallowable Medicare Payments for Inhalation Drugs (A-09-17-03019)
06-25-2018
Virginia Did Not Claim Some Medicaid Administrative Costs for Its Medallion 3.0 Waiver Program In Accordance With Federal Requirements (A-03-17-00200)
08-15-2018
Medicare Improperly Paid Hospitals Millions of Dollars for Intensity-Modulated Radiation Therapy Planning Services (A-09-16-02033)
Medicare Made Improper and Potentially Improper Payments for Emergency Ambulance Transports to Destinations Other Than Hospitals or Skilled Nursing Facilities (A-09-17-03017)
08-08-2018
California Claimed Millions of Dollars in Unallowable Federal Medicaid Reimbursement for Specialty Mental Health Services (A-09-15-02040)
California Created a Medicaid Program Vulnerability by Reporting Placeholders That Did Not Represent Actual Expenditures Supported by Documentation (A-09-15-02027)
08-09-2018
Maryland Did Not Adequately Secure Its Medicaid Data and Information Systems (A-18-16-30520)
Alaska Received Millions in Unallowable Bonus Payments (A-04-17-08059)
08-08-2018
CMS Did Not Always Accurately Authorize Financial Assistance Payments to Qualified Health Plan Issuers in Accordance With Federal Requirements During the 2014 Benefit Year (A-02-15-02013)
07-31-2018
Medicare Compliance Review of WakeMed Raleigh Campus (A-04-17-04057)
07-24-2018
Illinois Did Not Comply With Federal Waiver and State Requirements at 18 of 20 Adult Day Service Centers Reviewed (A-05-17-00028)
Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part A Administrative Costs for Fiscal Year 2013 (A-05-16-00052)
Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part B Administrative Costs for Fiscal Year 2013 (A-05-16-00053)
07-16-2018
First Coast Service Options, Inc., Did Not Claim Some Medicare Supplemental Executive Retirement Plan Costs Through Its Incurred Cost Proposals (A-07-18-00536)
First Coast Service Options, Inc., Generally Claimed Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-18-00534)
07-11-2018
Medicare Improperly Paid Providers for Nonemergency Ambulance Transports to Destinations Not Covered by Medicare (A-09-17-03018)
07-09-2018
The Colorado Health Insurance Marketplace�s Financial Management System Did Not Always Comply With Federal Requirements (A-07-17-02808)
07-05-2018
Medicare Improperly Paid Providers for Items and Services Ordered by Chiropractors (A-09-17-03002)
06-25-2018
Virginia Did Not Claim Some Medicaid Administrative Costs for Its Medallion 3.0 Waiver Program In Accordance With Federal Requirements (A-03-17-00200)
06-14-2018
Michigan Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Brokerage Program (A-05-16-00021)
06-07-2018
Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements (A-04-17-04056)
06-05-2018
Companion Data Services, LLC, Did Not Claim Some Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00528)
06-04-2018
New York Claimed Federal Reimbursement for Consumer-Directed Personal Assistance Services That Did Not Meet Medicaid Requirements (A-02-16-01026)
06-01-2018
University of Wisconsin Hospitals and Clinics Authority Incorrectly Billed Medicare Inpatient Claims With Severe Malnutrition (A-03-17-00005)
05-30-2018
Nebraska Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-07-17-03224)
Texas Made Increased Payments for Services Rendered by Eligible Primary Care Providers Under Federal Requirements (A-06-17-09003)
Minnesota Did Not Comply With Federal Waiver and State Requirements for All 20 Adult Day Care Centers Reviewed (A-05-17-00009)
05-29-2018
Nevada Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-09-15-02039)
05-22-2018
CMS Did Not Always Provide Accurate Medicaid Unit Rebate Offset Amounts to State Medicaid Agencies (A-07-17-06074)
05-14-2018
Iowa Complied With Most Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-07-17-03221)
Missouri Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-07-16-03216)
05-10-2018
Wisconsin Physicians Service Insurance Corporation Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00530)
Wisconsin Physicians Service Insurance Corporation Understated Medicare�s Share of the Medicare Segment Excess Pension Assets (A-07-17-00529)
04-30-2018
Cahaba Safeguard Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00526)
Cahaba Government Benefits Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00525)
Cahaba Government Benefits Administrators, LLC, Generally Claimed Allowable Medicare Pension Costs (A-07-17-00524)
04-27-18
Florida Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid  (A-04-17-08052)
04-25-2018
Cahaba Government Benefits Administrators, LLC, Overstated Its Medicare Segment Pension Assets (A-07-17-00522)
04-24-2018
Most of New York�s Claims for Federal Reimbursement for Monthly Personal Emergency Response Service Charges Did Not Comply With Medicaid Requirements (A-02-15-01019)
Cahaba Safeguard Administrators, LLC, Understated Its Medicare Segment Pension Assets (A-07-17-00523)
First Coast Service Options, Inc.�s, Postretirement Benefit Costs Were Reasonable and Allowable (A-07-17-00501)
04-18-2018
Colorado Did Not Always Comply With Federal Requirements When Expending Federal Establishment Grant Funds Allocated for Its Shared Eligibility System Costs (A-07-16-02804)
04-12-2018
CMS's Policies and Procedures Were Generally Effective in Ensuring That Prescription Drug Coverage Capitation Payments Were Not Made After the Beneficiaries' Dates of Death (A-07-16-05088)
04-05-2018
CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements (A-05-16-00058)
04-04-2018
Colorado Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services (A-07-16-03215)
Texas Did Not Make Increased Primary Care Provider Payments and Claim Reimbursement in Accordance With Federal Requirements (A-06-15-00045)
03-21-2018
New Jersey Claimed Federal Medicaid Reimbursement for Children's Partial Hospitalization Services That Did Not Meet Federal and State Requirements (A-02-16-01008)
03-20-2018
Idaho Received Millions in Unallowable Bonus Payments (A-04-17-08056)
03-16-2018
New York Did Not Comply With Federal Grant Requirements for Claiming Marketplace Contract Costs to Medicaid and the Children's Health Insurance Program  (A-02-15-01014)
03-14-2018
Many Medicare Claims for Outpatient Physical Therapy Services Did Not Comply With Medicare Requirements (A-05-14-00041)
03-08-2018
Hospitals Did Not Comply With Medicare Requirements for Reporting Certain Cardiac Device Credits (A-05-16-00059)
03-06-2018>
Oklahoma Did Not Have Procedures to Identify Provider-Preventable Conditions on Some Inpatient Hospital Claims (A-06-16-08004)
02-20-2018
California Made Medicaid Payments on Behalf of Newly Eligible Beneficiaries Who Did Not Meet Federal and State Requirements (A-09-16-02023)
02-16-2018
Arizona Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-09-16-02031)
02-14-2018
Medicare Improperly Paid Providers for Specimen Validity Tests Billed in Combination With Urine Drug Tests  (A-09-16-02034)
Wisconsin Physicians Service Paid Providers for Hyperbaric Oxygen Therapy Services That Did Not Comply With Medicare Requirements (A-01-15-00515)
02-13-2018
Medicare Compliance Review of Memorial University Medical Center (A-04-17-08055)
02-12-2018
Medicare Needs Better Controls To Prevent Fraud, Waste, and Abuse Related to Chiropractic Services (A-09-16-02042)
Arkansas Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-06-16-00018)
02-09-2018
Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2016 (A-18-17-11300)
01-31-2018
Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00506)
01-30-2018
CGS Administrators, LLC, Did Not Claim Some Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00513)
01-23-2018
Medicare Compliance Review of the University of Michigan Health System (A-05-16-00064)
01-11-2018
Medicare Compliance Review of Carolinas Medical Center (A-04-16-04049)
01-05-2018
Wisconsin Physicians Service Insurance Corporation Did Not Claim Some Allowable Medicare Pension Costs (A-07-17-00519)
Wisconsin Physicians Service Insurance Corporation Understated Its Allocable Pension Costs (A-07-17-00520)
New York Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries (A-02-15-01015)
01-04-2018
North Carolina Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-04-17-02500)
Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Employees' Pension Plan (A-07-17-00516)
Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Managerial Retirement Program for Selected Locations (A-07-17-00517)
Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Managerial Pension Plan (A-07-17-00518)