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Recent Postings from OIG

August 13, 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

The Patient Protection and Affordable Care Act (ACA) established marketplaces to allow individuals and small businesses to shop for health insurance in all 50 States and the District of Columbia. The Centers for Medicare & Medicaid Services (CMS) operates the Federal marketplace and is responsible for reviewing, approving, and generating financial assistance payments (i.e., advance premium tax credits and advance cost-sharing reductions) for the Federal and State-based marketplaces. During the 2014 benefit year, CMS used an interim process for approving financial assistance payments. We previously reviewed CMS’s internal controls under its interim process to ensure the accuracy of aggregate financial assistance payments and determined that the controls were not effective.
See Report

August 9, 2018

Questionable Billing for Compounded Topical Drugs in Medicare Part D

In 2016, OIG called attention to significant growth in spending for compounded drugs (customized medications tailored to meet the needs of individual patients). Specifically, OIG found that Medicare Part D spending for compounded drugs grew by 625 percent from 2006 to 2015 and spending for topical compounded drugs-such as creams, gels, and ointments to relieve pain-grew at an even faster pace.
See Report

Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2016 Average Sales Prices

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would only make this substitution only if the ASP for a drug exceeds the AMP by 5 percent in the 2 previous quarters or 3 of the previous 4 quarters.
See Report

August 1, 2018

Updated: Work Plan

The OIG has updated its work plan
See Updated Work Plan

Unimplemented Recommendations

Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations
See Report

Vulnerabilities in Hospice Care

OIG is committed to ensuring that beneficiaries receive quality care and to safeguarding the hospice benefit. The agency has completed extensive work on the hospice program, including numerous evaluations and audits. OIG has also conducted criminal and civil investigations of hospice providers, leading to the conviction of individuals, monetary penalties, and civil False Claims Act settlements.
See Report

July 17, 2018

Testimony

Testimony of Gloria L. Jarmon, Deputy Inspector General for Audit Services, Office of Inspector General, U.S. Department of Health and Human Services: House Committee on Ways and Means Subcommittee on Oversight: Combating Fraud in Medicare: A Strategy for Success
See Testimony

June 29, 2018

CMS Did Not Detect Some Inappropriate Claims for Durable Medical Equipment in Nursing Facilities

The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 directs OIG to monitor the appropriateness of Medicare payments for items and services—including durable medical equipment (DME)—provided during stays not covered by Medicare, called “noncovered stays,” in skilled nursing facilities (SNFs). CMS requires facilities to provide DME as a standard part of nursing care, and does not permit separate Medicare payment for DME except when Medicaid only nursing facilities serve as beneficiary homes.

See Report

OIG posts 2018 National Health Care Fraud Takedown information and three reports

The Department of Health and Human Services Office of Inspector General, along with our state and federal law enforcement partners, participated in the largest health care fraud takedown in history in June 2018. More than 600 defendants in 58 federal districts were charged with participating in fraud schemes involving about $2 billion in losses to Medicare and Medicaid. Since the last takedown, OIG also issued exclusion notices to 587 doctors, nurses, and other providers based on conduct related to opioid diversion and abuse.
See Report

Opioid Use in Medicare Part D Remains Concerning

The opioid crisis was recently declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States—115 deaths per day. This data brief is part of a larger strategy by OIG to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse. This data brief provides 2017 data on the extent to which Medicare Part D beneficiaries receive extreme amounts of opioids or appear to be doctor shopping and compares these data to OIG’s previous analysis of 2016. It also identifies prescribers who have questionable opioid prescribing.
See Report

June 27, 2018

OIG Updated: Work Plan

See Update

MEDICAID: Actions Needed to Mitigate Billions in Improper Payments and Program Integrity Risks

The Medicaid program helped provide health care to an estimated 73 million people in fiscal 2017 at a cost of about $596 billion. This joint federal and state program continues to grow, and remains on our high risk list due to concerns about the adequacy of federal oversight and the program's vulnerability to fraud.
See Report

April 16, 2018

New: Compliance Resource Portal https://go.usa.gov/xQjRJ

April 13, 2018

CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements

Medicare paid a total of $17.6 million in telehealth payments in 2015, compared with $61,302 in 2001. Medicare telehealth payments include a professional fee, paid to the practitioner performing the service at a distant site, and an originating-site fee, paid to the facility where the beneficiary receives the service. A Medicare Payment Advisory Commission study of 2009 claims found that Medicare professional fee claims without associated claims for originating-site facility fees were more likely to be associated with unallowable telehealth payments.

See Report

June 4, 2018

Increases in Reimbursement for Brand-Name Drugs in Part D

Recent increases in prescription drug prices have drawn the attention of Congress, made headlines in major media outlets, and raised concerns in Government agencies that reimburse for these drugs. Some studies also have shown that certain therapeutic classes of drugs—i.e., groups of drugs that treat specific conditions such as diabetes and heart disease—are becoming more expensive. Drugs in these therapeutic classes are typically maintenance drugs, which means they are usually prescribed for chronic conditions. Therefore, increasing costs for these drugs may have a long-term financial impact on Part D and its beneficiaries.
See Report

April 6, 2018

Health Care Fraud and Abuse Control Program Report FY 2017

See Report

March 29, 2018

Drug Supply Chain Security: Dispensers Received Most Tracing Information

Drug diversion, counterfeiting, and the importation of unapproved drugs may result in potentially dangerous drugs entering the drug supply chain, posing a threat to public health and safety. To enhance the security of this supply chain, the Drug Supply Chain Security Act (DSCSA) requires trading partners in the drug supply chain to create a record of each drug product transaction. The FDA can then use such records to investigate suspect and illegitimate drug products and potential diversion.

See Report

March 8, 2018

Federal Obligations to and Expenditures by Selected Organizations Involved in Health-Related Activities, Fiscal Years 2013-2015

In the 3-year period we examined, federal agencies obligated about $27 billion in funding to organizations that provide preventive, reproductive, and diagnostic health care services in the United States or abroad. These include:

  • federally qualified health centers,
  • International Planned Parenthood Federation,
  • Marie Stopes International, and
  • Planned Parenthood Federation of America.
Most of the funding came from two agencies: the Department of Health and Human Services (about $20 billion) and the U.S. Agency for International Development (about $76 million).

See Report

February 16, 2018

Medicare Needs Better Controls To Prevent Fraud, Waste, and Abuse Related to Chiropractic Services

This portfolio presents an overview of program vulnerabilities identified in prior Office of Inspector General audits, evaluations, investigations, and legal actions related to chiropractic services in the Medicare program. It consolidates the findings and issues identified in that work and discusses recommendations from prior reports that have not been implemented or have been implemented ineffectively. In addition, this portfolio provides information to help the Centers for Medicare & Medicaid Services understand the need for effective controls over chiropractic services and offers recommendations to help Medicare prevent fraud, waste, and abuse related to those services.

See Report

Ensuring Beneficiary Health and Safety in Group Homes

On February 7, 2018, a panel of experts from across the Department of Health and Human Services discussed workable, holistic solutions that States can use to protect the health and safety of residents living in a group home setting.

Watch the Discussion

Work Plan

Updated: Work Plan

January 16, 2018

Medicare Advantage Encounter Data Show Promise for Program Oversight, But Improvements Are Needed

For the Medicare Advantage (MA) program, CMS contracts with private insurance companies, known as MA organizations (MAOs), to provide Medicare coverage for 18.6 million beneficiaries. In fiscal year 2016, MA expenses reached $200 billion. In 2012, CMS began collecting detailed information from MAOs regarding each service provided to MA beneficiaries. This information is known as MA encounter data. These data must be accurate for CMS to review the medical care that beneficiaries are receiving and use the data to increase payments to MAOs for beneficiaries in poorer health. Ensuring the completeness, validity, and timeliness of the MA encounter data is also critical to safeguard program integrity and to ensure that MA beneficiaries receive needed medical care.

See Report Here

January 9, 2018

New York Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries

New York did not always determine Medicaid eligibility for newly eligible beneficiaries in accordance with Federal and State requirements. In our sample of 130 beneficiaries, New York correctly determined eligibility for 90 beneficiaries.

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Tennessee Managed Care Organizations Received Medicaid Capitation Payments After Beneficiary's Death

Tennessee did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Of the 120 capitation payments in our random sample selected from payments for beneficiaries whose dates of death (DODs) preceded the payment dates, Tennessee recovered 43 prior to the start of our audit, and 13 were not recoverable.

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Georgia Made Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid Identification Numbers

Georgia made capitation payments on behalf of beneficiaries who were assigned multiple Medicaid identification (ID) numbers. Of the 100 beneficiary matches in our sample, Georgia correctly claimed reimbursement for capitation payments on behalf of 28. However, Georgia incorrectly claimed multiple capitation payments that totaled $201,561 ($132,765 Federal share) on behalf of the remaining 72.

Read Report

Texas Did Not Bill Manufacturers for Some Rebates for Pharmacy Drugs of Medicaid Managed-Care Organizations

Texas did not fully comply with Federal Medicaid requirements for billing manufacturers for some rebates for pharmacy drugs dispensed to managed-care organization enrollees. Texas properly processed claims for rebates in most instances; however, some claims were bypassed in the Drug Rebate Analysis and Management System and were not processed for rebate. The bypassed claims occurred during the rebate billing for the second quarters of 2012 and 2014. These claims were bypassed because they were loaded during the rebate invoicing process and Texas did not perform the required invoice recalculation to ensure they were applied to the current quarter. The bypassed claims resulted in 220,336 claim lines that were not invoiced for rebate. The rebates associated with these claims total $7.8 million ($4.4 million Federal share).

Read Report

OIG Letter to PhRMA

Drug Companies that Provide Free Drugs to Federal Health Care Program Beneficiaries Impacted by Caring Voice Coalition, Inc.'s Decision Not to Provide Patient Assistance in 2018

See Letter

December 20,2017

Potential Misclassifications Reported by Drug Manufacturers May Have Led to $1 Billion in Lost Medicaid Rebates

Manufacturers with rebate agreements are required to report all of their covered outpatient drugs to the Medicaid Drug Rebate Program (Medicaid rebate program). CMS calculates rebate amounts using manufacturer reported pricing and classification data. Congress asked OIG to evaluate the accuracy of manufacturer reported data in the Medicaid rebate program, and CMS's oversight of that data. The Food and Drug Administration's (FDA's) marketing categories, which also are manufacturer reported, can be used to help determine whether a drug is classified as an innovator, e.g., brand name, or noninnovator, e.g., generic, product, for the purposes of calculating Medicaid rebates. Innovator products are generally subject to higher base rebate amounts. Manufacturers are required to pay an additional, inflation adjusted rebate if a drug's price increases faster than inflation. When information provided by drug manufacturers is incorrect or missing, State Medicaid agencies may not be able to collect all appropriate rebates.

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December 15, 2017

Updated OIG Work Plan

See Report

Followup Review: CMS's Management of the Quality Payment Program

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enacted clinician payment reforms designed to promote quality and value of care. These reforms, known as the Quality Payment Program (QPP), are a significant shift in how Medicare calculates compensation for clinicians and require CMS to develop a complex system for measuring, reporting, and scoring the value and quality of care. The first performance year began on January 1, 2017.

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November 30, 2017

Semiannual Report to Congress

See Report

November 27, 2017

Excluding Noncovered Versions When Setting Payment for Two Part B Drugs Would Have Resulted in Lower Drug Costs for Medicare and its Beneficiaries

A limited number of prescription drugs—generally those that are injected or infused in physicians' offices or hospital outpatient settings—are covered under Medicare Part B. With certain exceptions, Part B does not cover drugs that are self-administered by patients, including drugs administered by self-injection. However, in a small number of cases, self-administered drugs that typically would be used in situations not covered under Part B are being included by CMS when setting payment amounts.

See Report

September 5, 2017

Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2014 Average Sales Prices

The Social Security Act mandates that OIG compares ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeds the AMP by 5 percent in the 2 previous quarters or 3 of the previous 4 quarters.

See Report

Calculation of Potential Inflation-Indexed Rebates For Medicare Part B Drugs 2017

In an earlier report, OIG found that a rebate program for Part B drugs could have resulted in at least $2.7 billion in rebates (both basic rebate and inflation-indexed rebate segments) in 2011. OIG conducted this current review after receiving a congressional request asking us to update our earlier rebate calculations using only the inflation-indexed portion of the Medicaid rebate methodology.

See Report

August 28, 2017

The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements

This audit is part of the ongoing efforts of the Office of Inspector General (OIG) to detect and combat elder abuse. We are communicating these preliminary results because of the importance of detecting and combating elder abuse. Also, according to Government Auditing Standards, "early communication to those charged with governance or management may be important because of their relative significance and the urgency for corrective follow-up action."

See Report

July 17, 2017

OIG updates the Work Plan.

Updated Plan

July 6, 2017

Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2017

This report fulfills for 2017 the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA) for 2017. The ACA requires OIG to conduct a study of the extent to which formularies used by Medicare Part D plans include drugs commonly used by full benefit dual eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits). These individuals generally get drug coverage through Medicare Part D. Pursuant to the ACA, OIG must annually issue a report with recommendations as appropriate. This is the seventh report the OIG has produced to meet this mandate.

Read the Report

June 13, 2017

2016 Performance Data for the Senior Medicare Patrol Projects2016 Performance Data for the Senior Medicare Patrol Projects

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from ACL to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. OIG has collected these performance data since 1997.

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Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements

he Health Information Technology for Economic and Clinical Health Act established the Medicare and Medicaid electronic health record (EHR) incentive programs to promote the adoption of EHRs and to improve health care quality, safety, and efficiency through the promotion of health information technology and electronic health information exchange. As an incentive for using certified EHR technology, the Federal Government is making payments to eligible professionals (EPs) and hospitals that attest to the “meaningful use” of EHRs. To receive an incentive payment, EPs attest that they meet program requirements by self-reporting data through the Centers for Medicare & Medicaid Services’ (CMS) online system. he Health Information Technology for Economic and Clinical Health Act established the Medicare and Medicaid electronic health record (EHR) incentive programs to promote the adoption of EHRs and to improve health care quality, safety, and efficiency through the promotion of health information technology and electronic health information exchange. As an incentive for using certified EHR technology, the Federal Government is making payments to eligible professionals (EPs) and hospitals that attest to the “meaningful use” of EHRs. To receive an incentive payment, EPs attest that they meet program requirements by self-reporting data through the Centers for Medicare & Medicaid Services’ (CMS) online system.

Read the Report

June 8, 2017

Eye on Oversight Video: Abuse in Nursing Homes Eye on Oversight Video: Abuse in Nursing Homes

See Video

June 1, 2017

Spring 2017 Semiannual Report to Congress

This spring edition of the Semiannual Report to Congress covers OIG activities from October 2016 through March 2017. Historically, about 80 percent of OIG's resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization and content of the report.

See Report

May 19, 2017

Medicaid Fraud Control Units Fiscal Year 2016 Annual Report Medicaid Fraud Control Units Fiscal Year 2016 Annual Report

The Department of Health and Human Services (HHS) OIG is the designated Federal agency that oversees State Medicaid Fraud Control Units (MFCUs or Units). This MFCU Fiscal Year (FY) 2016 Annual Report highlights statistical achievements from the investigations and prosecutions the 50 MFCUs conducted for FYs 2012 through 2016. The report also identifies beneficial practices noted in OIG onsite review reports.

See Report

May 16, 2017

U.S. Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2016U.S. Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2016

The Office of Inspector General (OIG) must review the Department of Health and Human Services (HHS) compliance with the Improper Payments Information Act of 2002 (IPIA; P.L. No. 107-300) as amended by the Improper Payments Elimination and Recovery Act of 2010 (P.L. No. 111-204) and the Improper Payments Elimination and Recovery Improvement Act of 2012 (IPERIA; P.L. No. 112-248). Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year 2016 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with IPIA and related guidance from the Office of Management and Budget (OMB).The Office of Inspector General (OIG) must review the Department of Health and Human Services (HHS) compliance with the Improper Payments Information Act of 2002 (IPIA; P.L. No. 107-300) as amended by the Improper Payments Elimination and Recovery Act of 2010 (P.L. No. 111-204) and the Improper Payments Elimination and Recovery Improvement Act of 2012 (IPERIA; P.L. No. 112-248). Ernst & Young (EY), LLP, under its contract with the HHS OIG, audited the fiscal year 2016 HHS improper payment information reported in the Agency Financial Report (AFR) to determine compliance with IPIA and related guidance from the Office of Management and Budget (OMB).

Read the Report

March 16, 2017

Health Information Technology: HHS Should Assess the Effectiveness of Its Efforts to Enhance Patient Access to and Use of Electronic Health Information.

Data from the 2015 Medicare EHR Program show that relatively few patients electronically access their health information when offered the ability to do so. Patients GAO interviewed described primarily accessing health information before or after a health care encounter, such as reviewing the results of a laboratory test or sharing information with another provider.

See Report

2017 Compendium of Unimplemented Recommendations2017 Compendium of Unimplemented Recommendations

The Compendium of Unimplemented Recommendations (Compendium) is a core publication of the Department of Health and Human Services (HHS or Department) Office of Inspector General (OIG). In this edition, we focus on the top 25 unimplemented recommendations that, in OIG͛s view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and quality improvements and should, therefore, be prioritized for implementation. The recommendations come from OIG audits and evaluations performed pursuant to the Inspector General Act of 1978 (IG Act), as amended. The Appendix of the Compendium includes a broader list of significant unimplemented recommendations from OIG.

March 6, 2017

OIG posts statistical information for FY2016 Medicaid Fraud Control Units and enforcement actions

In FY 2016, State Medicaid Fraud Control Units (MFCUs) were responsible for 1,721 indictments, 1,564 convictions, and $1.8 billion in criminal and civil recoveries, as reported to OIG.

February 15, 2017

Drug Pricing and Reimbursement Web Portfolio

OIG posts a Drug Pricing and Reimbursement Web portfolio on its website. This portfolio, in development since last summer, pulls together the HHS OIG’s body of work since 2010 as well as other relevant items that relate to drug pricing and reimbursement in HHS programs. The portfolio features planned work, completed reports, industry guidance, and enforcement actions.

January 11, 2017

Final Rule: Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General's Exclusion Authorities

See Federal Register

January 5, 2017

High-Price Drugs Are Increasing Federal Payments for Medicare Part D Catastrophic Coverage

Federal payments for catastrophic coverage exceeded $33 billion in 2015, which is more than triple the amount paid in 2010. Spending for high-price drugs contributed significantly to this growth. By 2015, high-price drugs were responsible for almost two-thirds of the total drug spending in catastrophic coverage.

See Report

December 21, 2017

Early Implementation Review: CMS’s Management of the Quality Payment Program

CMS has made significant progress towards implementing the QPP. Although many milestones remain before the QPP payment adjustments in 2019, OIG identified two vulnerabilities that are critical for CMS to address in 2017, because of their potential impact on the program’s success: (1) providing sufficient guidance and technical assistance to ensure that clinicians are ready to participate in the QPP, and (2) developing IT systems to support data reporting, scoring, and payment adjustment.

See Report

December 19, 2017

Vulnerabilities Remain Under Medicare’s 2-Midnight Hospital Policy

We found that the number of inpatient stays decreased and the number of outpatient stays increased since the implementation of the 2-midnight policy. Further, short inpatient stays decreased more than long outpatient stays. Despite these changes, vulnerabilities still exist.

See Report

December 16, 2017

HHS-OIG Year in Review

The 2016 Year in Review highlights significant work in our continuing battle against fraud, waste, and abuse in Department of Health and Human Services programs, including Medicare and Medicaid.

Watch Video

November 10. 2016

FY 2017 Office of Inspector General Work Plan

The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services; the public health agencies; the Administrations for Children & Families; and Administration on Aging. Information is also provided on projects related to issues that cut across departmental programs, including State and local government use of Federal funds, as well as the functional areas of the Office of the Secretary of Health & Human Services (HHS).

See Work Plan

November 4. 2016

Eye on Oversight Video: Vulnerabilities in Personal Care Services

Investigations have revealed abuse and neglect by PCS attendants. OIG hopes that its recommendations to the Centers for Medicare and Medicaid Services will ensure that people in need of PCS services are not at risk of abuse or neglect.

See video

October 24. 2016

Arizona Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid

The Arizona Department of Health Services, Division of Licensing Services, Bureau of Long-Term Care Licensing (State agency), did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year (CY) 2014 in accordance with Federal requirements.

See Report
October 18. 2016

Video Series Eye on Oversight

Vulnerabilities in Personal Care Services

October 7. 2016

Medicare's Policies and Procedures Identified Almost All Improper Claims Submitted for Deceased Individuals and Recouped Almost All Improper Payments Made for These Claims for January 2013 Through October 2015

CMS had policies and procedures to ensure that payments were not made for Medicare services ostensibly rendered to deceased individuals. These policies and procedures generally ensured that CMS did not make improper payments when its data systems indicated at the time a claim was processed that the individual had died before the claimed date of service.

See Report

Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services During 2013 and 2014

CMS's policies and procedures generally prevented improper payments in cases when CMS's data systems identified a beneficiary as incarcerated at the time that a claim was processed. However, CMS's policies and procedures did not allow CMS to detect and recoup improper payments on a postpayment basis when CMS's data systems did not identify a beneficiary as incarcerated at the time that a claim was processed.

See Report

September 30. 2016

Medicare Improperly Paid Millions of Dollars for Unlawfully Present Beneficiaries for 2013 and 2014

The Centers for Medicare & Medicaid Services (CMS) had policies and procedures to ensure that payments were not made for Medicare services rendered to unlawfully present beneficiaries in accordance with Federal requirements, but it did not always follow those policies and procedures.

See Report

Video

Video Series Eye on Oversight: Critical Incidents in Group Homes

OIG Video report on recent findings in Connecticut and Massachusetts where group homes for the disabled did not report critical incidences to state authorities.

See video here

August 10. 2016

MACs Continue to Use Different Methods to Determine Drug Coverage

In keeping with the flexibility MACs have to make coverage decisions, MACs reported using a variety of information sources on drug uses to assist in making coverage determinations.

See Report Here

August 3. 2016

Podcast: July 2016 OIG Monthly Update

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