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Conflicting CMS Guidance and Federal Statutory Requirements Cost Medicare $380 Million Over a 6-Year Period for Organs Not Transplanted Into Medicare Enrollees

CMS Oversight Did Not Prevent Medicare Part D Sponsors From Making $587.7 Million in Ineligible Payments to Pharmacies for Drugs Available Over the Counter but Labeled as Prescription-Only

Arizona Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Health Share of Oregon Did Not Always Comply With Federal and State Requirements When Denying Prior Authorization Requests

Kansas Did Not Ensure That Its Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Medicare Home Health Agency Provider Compliance Audit: Deistic Home Health Care, Inc.

Medicare Improperly Paid Physicians an Estimated $15.2 Million for Sacroiliac Joint Injections

Connecticut Generally Claimed Medicaid Reimbursement for Clinical Diagnostic Laboratory Services in Accordance With Federal and State Requirements

Hospice of the Valley - West Received at Least $8.6 Million in Medicare Overpayments

Georgia Claimed at Least $26.1 Million More in Medicaid Reimbursements for Clinical Diagnostic Laboratory Services Than Was Allowed by Federal and State Requirements

Wisconsin Physicians Service Insurance Corporation Made Incorrect Medicare Payments to Providers for Outpatient Services

Colorado Could Improve Its Electronic Visit Verification System and Claimed Federal Medicaid Reimbursement for Millions of Dollars in Personal Care Services That Did Not Comply With Federal and State Requirements

Novitas Solutions, Inc., Improperly Paid Approximately $19.5 Million for Selected Medicare Part B Services Provided to Patients Residing in Nursing Homes

New York Should Improve Its Oversight of Nursing Homes’ Compliance With Background Check Requirements

Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees

CMS’s Processes Were Not Effective in Ensuring the Accuracy of Staffing Information Reported in the Payroll-Based Journal

Jefferson Regional Medical Center Received at Least $4.7 Million in Medicare Overpayments

North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings

A Small Southeastern Hospital Had Effective Cybersecurity Controls To Prevent, Detect, and Respond To Cyberattacks

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