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Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Priority Health (Contract H2320) Submitted to CMS

Louisiana Healthcare Connections Generally Complied With Federal and State Process Requirements When Denying Prior Authorization Requests

Selected Diabetes and Weight Loss Drugs Were Dispensed to Michigan Medicaid Managed Care Enrollees in Accordance With Federal and State Requirements

Medicare Home Health Agency Provider Compliance Audit: VNS Health

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Gateway Health Plan, Inc., (Contract H5932) Submitted to CMS

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross and Blue Shield of Alabama (Contract H0104) Submitted to CMS

Emergency Department Procedure Codes Used on Medicare Claims for Services Billed With Nonemergency Department Sites of Service Resulted in Over $15 Million in Improper and Potentially Improper Payments

Sarasota Memorial Hospital Received At Least $12.1 Million in Medicare Overpayments

Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children

Office of Inspector General’s Partnership With the Office of the Utah Inspector General: Inspector General’s Report Audit of Capitation Payments Made Concurrently With Another State

Medicare Home Health Agency Provider Compliance Audit: Alternate Solutions Homecare of Dayton

Missouri Did Not Obtain Millions of Dollars in Rebates for Medicaid Physician-Administered and Pharmacy Drugs

West Virginia Did Not Obtain Rebates Associated With Millions of Dollars in Medicaid Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations

A Large Southeastern Hospital Could Improve Certain Security Controls to Enhance Its Ability to Prevent and Detect Cyberattacks

Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed With Autism

Medicaid Agencies Made Millions in Unallowable Capitation Payments to Managed Care Organizations on Behalf of Deceased Enrollees

Audit of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2024

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

Essence Healthcare, Inc., Did Not Comply With Federal Requirement for Reporting Direct and Indirect Remunerations for Contract Years 2017 Through 2020

Medicare Home Health Agency Provider Compliance Audit: Guardian Home Care, LLC

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