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South Carolina Did Not Report Approximately $108.6 Million of the Federal Share of Medicaid and CHIP Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentage

Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program

Arkansas Failed to Comply With the Immediate Screening, Risk and Safety Assessment, and Investigation Requirements for Responding to Reports of Child Abuse and Neglect

Medicare Advantage Organizations and Prescription Drug Plans Paid $72 Million During a 3-Year Period for Services Associated With Excluded Providers or Individuals Convicted of Certain Felonies

Tennessee Claimed Federal Medicaid Reimbursement for Millions of Dollars in Targeted Case Management Services That Did Not Comply With Federal and State Requirements

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection

Many Independent Organ Procurement Organizations Did Not Meet Medicare Requirements for Reporting Kidney Transportation Costs and Some Did Not Transport Organs in Accordance With Medicare Requirements

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), Submitted to CMS

In 2024, ORR’s National Call Center Connected Children with Supports and Services

New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees

Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted Medical Loss Ratio Data Has Limitations

Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2024 Average Sales Prices

Connecticut Could Better Ensure That the Department of Developmental Services and Providers Fully Comply With Federal Waiver and State Health and Safety Requirements for Individualized Home Support Services

North Carolina Medicaid Fraud Control Unit: 2025 Onsite Inspection

Methodist Hospital Received at Least $12.4 Million in Medicare Overpayments

Medicare Hospital Provider Compliance Audit: McLeod Regional Medical Center

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract H5216) Submitted to CMS

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare of Wisconsin, Inc. (Contract H5253) Submitted to CMS

The IHS Navajo Area Office’s Internal Controls for Awarding, Monitoring, and Reporting Sanitation Facilities Construction Projects Could Be Improved

Medicare Advantage Organizations and CMS Can Do More To Prevent Durable Medical Equipment Fraud in Medicare Advantage

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