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

Potential Vulnerabilities in CMS’s Oversight of Medicare Providers’ Billing of Selected Outpatient Drugs

Four States Implemented Different Nursing Home Minimum Spending Requirements Related to Resident Care, and Three of These States and Some Nursing Homes Experienced Challenges

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

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

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

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

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

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

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

California Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys

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

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