Updated Work Plan

What's New

November 20, 2025

Updated: Annual Inflation Updates to the Annual Cap on Patient Engagement Tools and Supports Under 42 CFR § 1001.952(hh)

November 19, 2025

CMS Put $11.2 Billion at Risk of Fraud, Waste, and Abuse by Not Properly Closing Contracts A-04-24-02048

Dermatology Providers Generally Met Medicare Requirements for Evaluation and Management Services Performed on Same Day as Minor Surgical Procedures A-04-21-04083

November 18, 2025

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2025 OEI-03-26-00030

Enforcement Actions

November 19, 2025; U.S. Department of Justice

Founder/CEO and Clinical President of Digital Health Company Convicted in $100M Adderall Distribution and Health Care Fraud Scheme

November 19, 2025; U.S. Attorney's Office, District of Connecticut

Connecticut Dentists Pay More than $714K to Settle False Claims Allegations

November 19, 2025; U.S. Attorney's Office, Eastern District of Louisiana

Missouri Man Sentenced to 10 Years in Prison for $174 Million Health Care Fraud Conspiracy

What's Trending

1. Texas' Ambulance Services Supplemental Payment Program Did Not Comply With Federal and State Reimbursement Requirements
2. 2025 Top Unimplemented Recommendations
3. Charlotte Woman Pleads Guilty to $4.8 Million Medicaid Scheme, Aggravated Identity Theft, and Other Charges
4. Office of Inspector General's Partnership With the Office of the Kentucky State Auditor of Public Accounts: State Auditor's Report How Kentucky Failed to Prevent Over $800 Million of Medicaid Waste
5. West Virginia Did Not Comply With Intake, Screening, Assessment, and Investigation Requirements for Responding to Reports of Child Abuse and Neglect