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Centers for Medicare and Medicaid Services (CMS)

CMS Document Archive

2022

11-22-2022: Medicare Improperly Paid Physicians for Co-Surgery and Assistant-at-Surgery Services That Were Billed Without the Appropriate Payment Modifiers A-01-20-00503; Medicare Providers Did Not Always Comply With Federal Requirements When Billing for Advance Care Planning A-06-20-04008
11-18-2022: Puerto Rico MMIS and E&E Systems Security Controls Were Generally Effective, but Some Improvements Are Needed A-18-20-08005
11-17-2022: National Government Services, Inc., Accurately Calculated Hospice Cap Amounts but Did Not Collect All Cap Overpayments A-06-21-08004; The Centers for Medicare & Medicaid Services' Review Contractors Generally Conducted Medicaid Fee-for-Service Claim Reviews for Selected States Under the Payment Error Rate Measurement Program in Accordance with Federal and State Requirements A-04-21-00132
11-16-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That BCBS of Rhode Island (Contract H4152) Submitted to CMS A-01-20-00500
11-10-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That California Physicians' Service, Inc. (Contract H0504) Submitted to CMS A-09-19-03001
11-09-2022: The Number of Beneficiaries Who Received Medicare Part B Clinical Laboratory Tests Decreased During the First 10 Months of the COVID-19 Pandemic A-09-21-03004; Iowa Implemented Most of Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Major Incidents A-07-21-06105
10-27-2022: Mississippi Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-06101
10-26-2022: CMS Can Use OIG Audit Reports To Improve Its Oversight of Hospital Compliance A-04-21-08084
10-25-2022: California Made Almost $16 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Client Index Numbers A-04-21-07097; Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for 70 Percent of the State's Medicaid Fraud Control Unit Cases A-07-21-02834; CMS Generally Ensured That Medicare Part C and Part D Sponsors Did Not Pay Ineligible Providers for Services to Medicare Beneficiaries A-02-20-01027
10-24-2022: Payments Made to Providers Under the COVID-19 Accelerated and Advance Payments Program Were Generally in Compliance with the CARES Act and Other Federal Requirements A-05-20-00053
09-30-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract R5826) Submitted to CMS A-05-19-00039
09-29-2022: Texas Claimed or May Have Claimed More Than $30 Million of $9.89 Billion in Federal Funds for Medicaid Uncompensated Care Payments That Did Not Meet Federal and State Requirements; Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Highmark Senior Health Company (Contract H3916) Submitted to CMS A-03-19-00001
09-28-2022: Medicare Dialysis Services Provider Compliance Audit - Dialysis Clinic, Inc. A-05-20-00010
09-29-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That BlueCross BlueShield of Tennessee, Inc. (Contract H7917) Submitted to CMS A-07-19-01195
09-26-2022: Medicare Advantage Compliance Audit of Diagnosis Codes That Inter Valley Health Plan, Inc. (Contract H0545), Submitted to CMS A-05-18-00020
09-23-2022: Medicare Hospice Provider Compliance Audit: Hospice of Palm Beach County, Inc. A-02-20-01001
09-22-2022: CMS's System Edits Significantly Reduced Improper Payments to Acute-Care Hospitals After May 2019 for Outpatient Services Provided to Beneficiaries Who Were Inpatients of Other Facilities A-09-22-03007
09-21-2022: End-Stage Renal Disease Network Organizations' Reported Actions Taken in Response to the COVID-19 Pandemic A-05-20-00051
09-20-2022: New York Generally Determined Eligibility for Its Basic Health Program Enrollees in Accordance With Program Requirements A-02-20-01028
09-19-2022: Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States A-05-20-00025; Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services A-06-21-05003
09-15-2022: Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00004
09-14-2022: Tennessee Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-21-06096
09-13-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Regence BlueCross BlueShield of Oregon (Contract H3817) Submitted to CMS A-09-20-03009
09-12-2022: New York Claimed $196 Million, Over 72 Percent of the Audited Amount, in Federal Reimbursement for NEMT Payments to New York City Transportation Providers That Did Not Meet or May Not Have Met Medicaid Requirements A-02-21-01001
08-29-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That WellCare of Florida, Inc., (Contract H1032) Submitted to CMS A-04-19-07084
08-26-2022: Montana Claimed Federal Medicaid Reimbursement for More Than $5 Million in Targeted Case Management Services That Did Not Comply With Federal and State Requirements A-07-21-03246
08-19-2022: Medicare Advantage Compliance Audit of Diagnosis Codes That Cigna HealthSpring of Florida, Inc. (Contract H5410) Submitted to CMS A-03-18-00002
08-10-2022: South Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-07003
07-27-2022: Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2021 A-18-22-11300
07-26-2022: Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00005
07-25-2022: CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits A-04-18-03085
07-19-2022: Medicare Critical Care Services Provider Compliance Audit: Lahey Clinic, Inc. A-03-20-00002
07-18-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cariten Health Plan, Inc., (Contract H4461) Submitted to CMS A-02-20-01009
07-15-2022: Audits of Nursing Home Life Safety and Emergency Preparedness in Eight States Identified Noncompliance With Federal Requirements and Opportunities for the Centers for Medicare & Medicaid Services to Improve Resident, Visitor, and Staff Safety A-02-21-01010
07-14-2022: Medicare Hospice Provider Compliance Audit: Vitas Healthcare Corporation of Florida A-02-19-01018
07-05-2022: The Reduced Outlier Threshold Applied to Transfer Claims Did Not Significantly Increase Medicare Payments to Hospitals A-05-19-00019
06-29-2022: The Centers for Medicare & Medicaid Services Had Policies and Procedures in Place To Mitigate Vulnerabilities in a Timely Manner, but Improvements Are Needed A-18-20-06500
06-23-2022: More Than 90 Percent of the New Hampshire Managed Care Organization and Fee-for-Service Claims for Opioid Treatment Program Services Did Not Comply With Medicaid Requirements A-01-20-00006; An Estimated 91 Percent of Nursing Home Staff Nationwide Received the Required COVID-19 Vaccine Doses, and an Estimated 56 Percent of Staff Nationwide Received a Booster Dose A-09-22-02003
06-10-2022: Medicare and Beneficiaries Paid Substantially More to Provider-Based Facilities in Eight Selected States in Calendar Years 2010 Through 2017 Than They Paid to Freestanding Facilities in the Same States for the Same Type of Services A-07-18-02815
06-06-2022: Maine Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00007
05-25-2022: Texas Did Not Report and Return All Medicaid Overpayments for the State's Medicaid Fraud Control Unit's Cases A-06-20-04004; Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Peoples Health Network (Contract H1961) Submitted to CMS A-06-18-05002; Vanderbilt University Medical Center: Audit of Outpatient Outlier Payments A-06-20-04003
05-31-2022: Medicare Improperly Paid Durable Medical Equipment Suppliers an Estimated $8 Million of the $40 Million Paid for Power Mobility Device Repairs A-09-20-03016
05-24-2022: Selected Dialysis Companies Implemented Additional Infection Control Policies and Procedures To Protect Beneficiaries and Employees During the COVID-19 Pandemic A-05-20-00052
05-13-2022: Washington State Did Not Comply With Federal and State Requirements for Claiming Enhanced Federal Reimbursement for Medicaid Managed-Care Health Home Service Expenditures A-09-20-02008
04-25-2022: Massachusetts Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-00003
04-20-2022: California Improperly Claimed at Least $23 Million of $260 Million in Total Medicaid Reimbursement for Opioid Treatment Program Services A-09-20-02009
04-07-2022: Posthospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries in Indiana Generally Met Medicare Level-of-Care Requirements A-05-20-00005
04-01-2022: South Carolina Did Not Fully Comply With Requirements for Reporting and Monitoring Critical Events Involving Medicaid Beneficiaries With Developmental Disabilities A-04-18-07078
03-29-2022: Psychotherapy Services Billed by a New York City Provider Did Not Comply With Medicare Requirements A-02-21-01006
03-14-2022: New Mexico Did Not Claim $12.4 Million of $222.6 Million in Medicaid Payments for Services Provided by Indian Health Service Facilities in Accordance With Federal and State Requirements A-06-19-09005
03-08-2022: New Jersey's Medicaid School-Based Cost Settlement Process Could Result in Claims That Do Not Meet Federal Requirements A-02-20-01012
03-02-2022: The Centers for Medicare & Medicaid Services' Eligibility Review Contractor Adequately Determined Medicaid Eligibility for Selected States Under the Payment Error Rate Measurement Program A-02-20-01006
02-22-2022: Hospitals Did Not Always Meet Differing Medicare Contractor Specifications for Bariatric Surgery A-09-20-03007
02-18-2022: Office of Inspector General's Partnership With the Oregon Secretary of State's Audits Division: Oregon Health Authority-Timely Notification of Inpatient Hospital Stays Could Help Reduce Improper Medicaid Payments A-09-22-02001
02-15-2022: New York Verified That Medicaid Assisted Living Program Providers Met Life Safety and Emergency Planning Requirements But Did Not Always Ensure That Assisted Living Program Services Met Federal and State Requirements A-02-19-01017
02-14-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Tufts Health Plan (Contract H2256) Submitted to CMS A-01-19-00500; Medicare Payments of $6.6 Billion to Nonhospice Providers Over 10 Years for Items and Services Provided to Hospice Beneficiaries Suggest the Need for Increased Oversight A-09-20-03015
02-03-2022: Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan (Contract H5425) Submitted to CMS A-07-17-01169
02-01-2022: Prior Audits of Medicaid Eligibility Determinations in Four States Identified Millions of Beneficiaries Who Did Not or May Not Have Met Eligibility Requirements A-02-20-01018
01-24-2022: Independent Attestation Review: Centers for Medicare & Medicaid Services Fiscal Year 2021 Detailed Accounting Submission and Budget Formulation Compliance Report for National Drug Control Activities, and Accompanying Required Assertions A-03-22-00351
01-05-2022: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Healthfirst Health Plan, Inc., (Contract H3359) Submitted to CMS A-02-18-01029
01-04-2022: Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Excess Pension Assets as of December 31, 2016 A-07-21-00603; Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2014 Through 2016 A-07-21-00602; Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals for Calendar Years 2014 Through 2016 A-07-21-00605; Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Postretirement Benefit Assets as of January 1, 2017 A-07-21-00604

2021

12-22-2021: Arkansas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-01003
12-16-2021: Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern A-09-20-03027; Medicare Hospital Provider Compliance Audit: St. Joseph's Hospital Health Center A-02-20-01004
12-07-2021: Medicare Could Have Saved Approximately $993 Million in 2017 and 2018 if It Had Implemented an Inpatient Rehabilitation Facility Transfer Payment Policy for Early Discharges to Home Health Agencies A-01-20-00501
12-03-2021: Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation Sessions A-09-21-03002
12-02-2021: Kentucky Made Almost $2 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Medicaid ID Numbers A-04-20-07094
11-22-2021: CMS Should Strengthen Its Prescription Drug Event Guidance To Clarify Reporting of Sponsor Margin for Medicare Part D Bids A-03-17-00001
11-17-2021: Missouri Properly Converted Provisionally Enrolled Medicaid Providers to Permanent Providers A-07-21-03248
11-16-2021: Medicare Improperly Paid Suppliers an Estimated $117 Million Over 4 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Hospice Beneficiaries A-09-20-03026
11-05-2021: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UPMC Health Plan, Inc. (Contract H3907) Submitted to CMS A-07-19-01188
10-28-2021: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health Care of Missouri, Inc. (Contract H2663) Submitted to CMS A-07-17-01173
10-25-2021: Office of Inspector General's Partnership With the Commonwealth of Massachusetts Office of the State Auditor: Office of Medicaid (MassHealth) - Payments for Hospice-Related Services for Dual-Eligible Members A-01-20-00001
10-21-2021: Michigan Did Not Report Calendar Year 2019 Medicaid Third-Party Liability Cost Avoidance Data to the Centers for Medicare & Medicaid Services A-05-20-00058
10-19-2021: Tennessee Medicaid Claimed Hundreds of Millions of Federal Funds for Certified Public Expenditures That Were Not in Compliance With Federal Requirements A-04-19-04070
10-13-2021: Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic A-06-20-04007
10-01-2021: Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries A-01-18-00500
09-24-2021: Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic A-01-20-00508
09-22-2021: California Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-09-19-02004
09-21-2021: About Seventy-Nine Percent of Opioid Treatment Program Services Provided to Medicaid Beneficiaries in Colorado Did Not Meet Federal and State Requirements A-07-20-04118
09-20-2021: Minnesota Medicaid Managed Care Entities Used a Majority of Medicaid Funds Received for Medical Expenses and Quality Improvement Activities A-05-18-00018
09-08-2021: Colorado Did Not Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-17-06075
09-07-2021: An Ophthalmology Clinic in Florida: Audit of Medicare Payments for Eye Injections of Avastin, Eylea, and Lucentis A-09-19-03025
09-01-2021: CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data A-09-20-02005; Kansas Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-07-20-05125
08-25-2021: CGS Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00613; CMS Needs To Issue Regulations Related to Phlebotomy Travel Allowances A-06-20-04000; CGS Administrators, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00612
08-18-2021: Medicare Home Health Agency Provider Compliance Audit: Catholic Home Care A-02-19-01013; Medicare Hospital Provider Compliance Audit: Jewish Hospital A-04-19-08077; CGS Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00593; CGS Administrators, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00608
08-13-2021: Medicare Paid New Hospitals Three Times More for Their Capital Costs Than They Would Have Been Paid Under the Inpatient Prospective Payment System A-07-19-02818
08-12-2021: Oklahoma's Oversight of Medicaid Outpatient Services for Opioid Use Disorder Was Generally Effective A-06-20-08000; Missouri Claimed Federal Reimbursement for $3.4 Million in Payments to Health Home Providers That Did Not Meet Medicaid Requirements A-07-20-04117
08-10-2021: Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00616; Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-00615; Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00614; Companion Data Services, LLC, Supplemental Executive Retirement Plan III Costs Claimed Through Incurred Cost Proposals Were Allowable and Reasonable A-07-21-00611; Companion Data Services, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00610; Companion Data Services, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00609; Palmetto Government Benefits Administrator, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00592
08-06-2021: Almost All of the Medicare Pension Costs That Companion Data Services, LLC, Claimed Through Its Incurred Cost Proposals Were Allowable A-07-20-00594; Medicare Continues To Make Overpayments for Chronic Care Management Services, Costing the Program and Its Beneficiaries Millions of Dollars A-07-19-05122
07-28-2021: Almost 15 Percent of Arkansas' Private Contractor Costs Were Either Unallowable or Claimed at Higher Federal Matching Rates Than Eligible, Resulting in Arkansas Inappropriately Claiming $4.4 Million in Federal Medicaid Funds A-06-18-09002
07-21-2021: Texas Made Unallowable Children's Health Insurance Program Payments for Beneficiaries Assigned More Than One Identification Number A-06-20-10003
07-20-2021: Palmetto GBA, LLC, Accurately Calculated Hospice Cap Amounts but Did Not Collect All Cap Overpayments A-06-19-08003; New York Improperly Claimed $439 Million In Medicaid Funds for Its School-Based Health Services Based on Certified Public Expenditures A-02-18-01019
07-12-2021: Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2020 A-18-21-11300; Audit of Medicare Part D Pharmacy Fees: Group Health Cooperative, Inc. A-03-19-00002; Medicare Hospice Provider Compliance Audit: Partners In Care, Inc. A-09-18-03024
07-08-2021: Medicare Hospice Provider Compliance Audit: Mission Hospice & Home Care, Inc. A-09-18-03009; The Centers for Medicare & Medicaid Services Did Not Account for National Security Risks in Its Enterprise Risk Management Processes A-18-20-06200
07-07-2021: Medicare Payments for Transitional Care Management Services Generally Complied With Federal Requirements, but Some Overpayments Were Made A-07-17-05100; New York's Claims for Federal Reimbursement for Payments to Health Home Providers on Behalf of Beneficiaries Diagnosed With Serious Mental Illness or Substance Use Disorder Generally Met Medicaid Requirements But It Still Made $6 Million in Improper Payments to Some Providers A-02-19-01007
06-30-2021: Indiana Received Over $22 Million in Excess Federal Funds Related to Unsupported Community Integration and Habilitation Waiver Services at 12 Selected Service Providers A-05-19-00022; Medicare Hospital Provider Compliance Audit: Lake Hospital System A-05-19-00024
06-24-2021: CMS's Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals A-02-21-01003; Medicare Hospital Provider Compliance Audit: Staten Island University Hospital A-02-18-01025; Kentucky Claimed Millions in Unallowable School-Based Medicaid Administrative Costs A-04-17-00113
06-23-2021: Medicare Hospice Provider Compliance Audit: Northwest Hospice, LLC A-09-20-03035
06-10-2021: Nebraska Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for 76 Percent of the State's Medicaid Fraud Control Unit Cases A-07-18-02814; Medicare Hospice Provider Compliance Audit: Professional Healthcare at Home, LLC A-09-18-03028
06-09-2021: California Did Not Ensure That Nursing Facilities Always Reported Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Properly A-09-19-02005
06-08-2021: Opportunities Exist for CMS and Its Medicare Contractors To Strengthen Program Safeguards To Prevent and Detect Improper Payments for Drug Testing Services A-09-20-03017
06-03-2021: University of Michigan Health System: Audit of Medicare Payments for Polysomnography Services A-04-20-07088
06-02-2021: New Mexico Did Not Bill Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-06-16-00001
05-28-2021: Medicare Home Health Agency Provider Compliance Audit: Caretenders of Jacksonville, LLC A-04-16-06195
05-25-2021: Blue Cross Blue Shield of South Carolina Overstated Its Excess Plan Partial Medicare Segment Pension Assets as of January 1, 2017 A-07-21-00607
05-24-2021: Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments A-07-19-05117
05-21-2021: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS A-07-19-01187
05-20-2021: Sleep Management, LLC: Audit of Claims for Monthly Rental of Noninvasive Home Ventilators A-04-18-04066
05-18-2021: Medicare Hospice Provider Compliance Audit: Franciscan Hospice A-09-20-03034
05-14-2021: Medicare Hospice Provider Compliance Audit: Alive Hospice, Inc. A-09-18-03016; Medicare Hospice Provider Compliance Audit: Ambercare Hospice, Inc. A-09-18-03017
05-13-2021: CMS Needs to Strengthen Regulatory Requirements for Medicare Part B Outpatient Cardiac and Pulmonary Rehabilitation Services to Ensure Providers Fully Meet Coverage Requirements A-02-18-01026
05-11-2021: New York Made Unallowable Payments Totaling More Than $9 Million to the Same Managed Care Organization for Beneficiaries Assigned More Than One Medicaid Identification Number A-02-20-01007; Medicare Could Have Saved up to $20 Million Over 5 Years if CMS Oversight Had Been Adequate To Prevent Payments for Medically Unnecessary Cholesterol Blood Tests A-09-19-03027
05-07-2021: Medicare Hospice Provider Compliance Audit: Suncoast Hospice A-02-18-01001
05-06-2021: Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00032
05-05-2021: Louisiana Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-02005
05-04-2021: Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital A-02-18-01018
04-27-2021: Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Maryland A-03-17-00009
04-21-2021: Office of Inspector General's Partnership with the Office of the New York State Comptroller: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare A-02-21-01008
04-19-2021: Medicare Advantage Compliance Audit of Diagnosis Codes That Humana, Inc., (Contract H1036) Submitted to CMS A-07-16-01165
04-12-2021: Georgia Generally Ensured That Nursing Facilities Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Prioritized Allegations Timely A-04-17-03084
04-08-2021: Blue Cross Blue Shield of South Carolina Overstated Its Supplemental Executive Retirement Plan III Medicare Allowable Segment Pension Assets as of January 1, 2017 A-07-20-00600
04-08-2021: Palmetto Government Benefits Administrator, LLC, Overstated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00598
04-07-2021: Noridian Healthcare Solutions, LLC, Claimed Unallowable Medicare Nonqualified Restoration Savings Plan Costs Through Its Incurred Cost Proposals A-07-20-00591
03-31-2021: Medicare Hospital Provider Compliance Audit: Sunrise Hospital & Medical Center A-04-19-08075
03-29-2021: Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds A-06-19-02000
03-23-2021: Companion Data Services, LLC, Properly Updated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-21-00606
03-29-2021: An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis A-09-19-03022
03-17-2021: North Mississippi Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07086
03-04-2021: Peninsula Regional Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07087; Florida Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Did Not Always Assess, Prioritize, or Investigate Reported Incidents A-04-17-08058
03-01-2021: CMS Authorized Hundreds of Millions of Dollars in Advanced Premium Tax Credits on Behalf of Enrollees Who Did Not Make Their Required Premium Payments A-02-19-02005
02-25-2021: Medicare Home Health Agency Provider Compliance Audit: Brookdale Home Health, LLC A-04-18-06221
02-24-2021: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross Blue Shield of Michigan (Contract H9572) Submitted to CMS A-02-18-01028
02-22-2021: Medicare Hospice Provider Compliance Audit: Tidewell Hospice, Inc. A-02-18-01024
02-19-2021: Noridian Healthcare Solutions, LLC, Made Improper Medicare Payments of $4 Million to Physicians in Jurisdiction E for Spinal Facet-Joint Injections A-09-20-03010
02-16-2021: New York Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-02-17-01026; Iowa Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-19-03238
02-03-2021: Illinois Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00031
01-27-2021: Louisiana Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-06-18-02000
01-25-2021: California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider's Opioid Treatment Program Services A-09-20-02001
01-21-2021: Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program A-01-19-00004
01-15-2021: CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing Program Data To Identify and Focus on Error-Prone Providers A-05-17-00023
01-13-2021: Medicare Home Health Agency Provider Compliance Audit: Southeastern Home Health Services A-03-17-00004

2020

12-30-2020: The Centers for Medicare & Medicaid Services Could Improve Its Wage Index Adjustment for Hospitals in Areas With the Lowest Wages
12-22-2020: Medicare Home Health Agency Provider Compliance Audit: Tender Touch Health Care Services A-04-18-07077
12-21-2020: Aspects of Texas' Quality Incentive Payment Program Raise Questions About Its Ability To Promote Economy and Efficiency in the Medicaid Program A-06-18-07001
12-16-2020: Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Tullahoma, Tennessee A-02-16-01024
12-16-2020: Medicare Hospital Provider Compliance Audit: Providence Medical Center A-07-18-05113
12-11-2020: Risk Assessment Puerto Rico Medicaid Program A-02-20-01011
12-09-2020: New York Improved Its Monitoring of Its Personal Care Services Program But Still Made Improper Medicaid Payments of More Than $54 Million A-02-19-01016
12-07-2020: Medicare Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC A-06-16-05005
12-01-2020: Nebraska Claimed Almost All Medicaid Payments for Targeted Case Management Services in Accordance With Federal Requirements but Claimed Some Unallowable Duplicate Payments A-07-19-03239
11-24-2020: Florida Received Unallowable Medicaid Reimbursement for School-Based Services A-04-18-07075
11-19-2020: Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Payson, Arizona. A-02-16-01023
11-18-2020: Medicare Home Health Agency Provider Compliance Audit: The Palace at Home A-04-17-07067
11-17-2020: Cahaba Government Benefits Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00577; Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00578
11-16-2020: Hospitals Did Not Comply With Medicare Requirements for Reporting Cardiac Device Credits A-01-18-00502
11-12-2020: Ohio Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00023; Medicare Hospital Provider Compliance Audit: Edward W. Sparrow Hospital A-05-18-00045
11-10-2020: Ohio Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-05-18-00027
11-05-2020: Cahaba Government Benefits Administrators, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00575; Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00576
11-04-2020: CMS Did Not Ensure That Medicare Hospital Payments for Claims That Included Medical Device Credits Were Reduced in Accordance With Federal Regulations, Resulting in as Much as $35 Million in Overpayments A-07-19-00560
10-29-2020: Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc. A-02-17-01025
10-22-2020: Massachusetts Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-06-18-04001
10-21-2020: Minnesota Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00018
10-16-2020: Medicare Home Health Agency Provider Compliance Audit: Gem City Home Care, LLC A-05-18-00011; Medicare Hospital Provider Compliance Audit: St Francis Hospital A-05-18-00048
10-14-2020: Cedars-Sinai Medical Center: Audit of Medicare Payments for Bariatric Surgeries A-09-18-03010
10-09-2020: Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period A-09-20-03003
10-07-2020: Update on Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic A-09-20-01000
10-02-2020: Colorado Improperly Claimed Millions in Enhanced Federal Medicaid Reimbursement for New Adult Group Beneficiaries Because of a Data Processing Error A-07-17-02807; Medicare Critical Care Services Provider Compliance Audit: Clinical Practices of the University of Pennsylvania A-03-18-00003
09-30-2020: Medicare Hospital Provider Compliance Audit: Alta Bates Summit Medical Center A-04-19-08071
09-25-2020: North Carolina Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-04-16-00112
09-22-2020: Oregon's Oversight Did Not Ensure That Four Coordinated-Care Organizations Complied With Selected Medicaid Requirements Related to Access to Care and Quality of Care A-09-18-03035; CMS's Monitoring Activities for Ensuring That Medicare Accountable Care Organizations Report Complete and Accurate Data on Quality Measures Were Generally Effective, but There Were Weaknesses That Could Be Improved A-09-18-03033
09-21-2020: Connecticut Did Not Meet Federal and State Requirements for Claiming Medicaid School-Based Child Health Services for Hartford Public Schools A-01-19-00003
09-18-2020: North Carolina Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-19-08070; Vermont Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-19-06086
09-17-2020: Illinois Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-05-18-00037
09-16-2020: Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations A-07-17-01176; Medicare-Allowed Charges for Noninvasive Ventilators Are Substantially Higher Than Payment Rates of Select Non-Medicare Payers A-05-20-00008; Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals A-07-20-00590
09-14-2020: Maine Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-18-06079
09-11-2020: Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services A-05-18-00035; Group Health Incorporated Overstated Its Allowable Medicare Supplemental Executive Retirement Plan Costs for Calendar Years 2009 Through 2016 A-07-19-00582; Group Health Incorporated Claimed Some Unallowable Medicare Postretirement Benefit Costs for Calendar Years 2009 Through 2016 A-07-19-00583; Group Health Incorporated Overstated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of December 31, 2015 A-07-19-00579; Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of August 31, 2016 A-07-19-00580; Group Health Incorporated Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2009 Through 2016 A-07-19-00581
09-08-2020: Indiana Did Not Ensure That Medicaid Payments Were Made Properly for Some Claims Identified as Having Third-Party Coverage A-05-18-00046
09-04-2020: Audit of Medicare Part D Pharmacy Fees: Horizon Blue Cross Blue Shield, Inc. A-03-18-00007
09-03-2020: Baylor Scott & White—College Station: Audit of Outpatient Outlier Payments A-06-18-04003
09-01-2020: Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group A-07-19-02822; Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center A-07-18-05112
08-27-2020: Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program A-06-17-09002
08-25-2020: Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00017; Illinois Claimed Unallowable Telemedicine Payments A-05-18-00028; Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements A-05-18-00043; Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process A-05-18-00024
08-21-2020: CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete A-05-16-00051
08-19-2020: New Jersey Did Not Ensure That Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries Residing in Nursing Facilities Were Always Properly Investigated and Reported A-02-18-01006
08-18-2020: Indiana Properly Reported Adjustments Related to the Drug Rebate Program A-05-19-00028
08-14-2020: Nebraska Claimed Unallowable School-Based Administrative Costs Because of Improper Coding of Random Moment Timestudy Responses A-07-19-03234
08-11-2020: Medicare Home Health Agency Provider Compliance Audit: Mission Home Health of San Diego, Inc. A-09-18-03008
08-10-2020: Visionquest Industries, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03010; Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc. A-02-17-01022
08-06-2020: Desoto Home Health Care, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03021
08-05-2020: Inadequate Edits and Oversight Caused Medicare To Overpay More Than $267 Million for Hospital Inpatient Claims With Post-Acute-Care Transfers to Home Health Services A-04-18-04067
08-04-2020: Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2019 A-18-20-11300
07-29-2020: North Carolina Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse and Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Timely A-04-17-04063
07-27-2020: The New York State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-04-19-06223
07-24-2020: Factsheet: Ohio's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-05-19-00036
07-22-2020: CMS Could Have Saved $192 Million by Targeting Home Health Claims for Review With Visits Slightly Above the Threshold That Triggers a Higher Medicare Payment A-09-18-03031
07-21-2020: On-Site Psychological Services, P.C.: Audit of Medicare Payments for Psychotherapy Services A-02-19-01012; Alaska Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-09-19-02001
07-15-2020: CMS Did Not Administer and Manage Strategic Communications Services Contracts in Accordance With Federal Requirements A-12-19-20003
07-13-2020: Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims A-03-17-00010
07-10-2020: Medicaid Data Can Be Used To Identify Instances of Potential Child Abuse or Neglect A-01-19-00001
07-09-2020: Texas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-04003
07-06-2020: Freedom Orthotics, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03012
06-03-2020: Texas Telemedicine Services Were Provided in Accordance with State Requirements A-06-18-05001
06-01-2020: New Jersey Did Not Ensure That Its Managed Care Organizations Adequately Assessed and Covered Medicaid Beneficiaries' Needs for Long-Term Services and Supports A-02-17-01018
05-22-2020: Medicare Hospital Provider Compliance Audit: The Ohio State University Hospital A-05-18-00042
05-01-2020: Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays A-01-17-00508
04-29-2020: North Carolina Received $30 Million in Excess Federal Funds Related to Improperly Claimed Health Home Expenditures A-04-18-00120
04-20-2020: Grand Desert Psychiatric Services: Audit of Medicare Payments for Psychotherapy Services A-09-19-03018
04-17-2020: Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-20-00589; Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Pension Costs A-07-20-00588; Companion Data Services, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00587; Palmetto Government Benefits Administrator, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00586
04-16-2020: Recommendation Followup: Michigan Did Not Report and Refund the Full Federal Share of Medicaid Overpayments A-05-18-00022
04-09-2020: Medicare Home Health Agency Provider Compliance Audit: Residential Home Health A-05-16-00063; An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare's Medical Necessity or Documentation Requirements A-01-16-00508
04-07-2020: New York Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-02-18-01016; Iowa Inadequately Monitored Its Medicaid Health Home Providers, Resulting in Tens of Millions in Improperly Claimed Reimbursement A-07-18-04109
04-01-2020: 96 Percent of South Carolina's Medicaid Fee-for-Service Telemedicine Payments Were Insufficiently Documented or Otherwise Unallowable A-04-18-00122
03-27-2020: Medicare Hospital Provider Compliance Audit: Forbes Hospital A-03-18-00005; Iowa Did Not Comply With Federal and State Requirements for Major Incidents Involving Medicaid Members With Developmental Disabilities A-07-18-06081
03-26-2020: New York's Oversight of Medicaid Managed Care Organizations Did Not Ensure Providers Complied With Health and Safety Requirements at 18 of 20 Adult Day Care Facilities Reviewed A-02-18-01027
03-25-2020: Medicare Dialysis Services Provider Compliance Review: Bio-Medical Applications of Arecibo, Inc. A-02-17-01016
03-24-2020: Most of the Non-Newly Eligible Beneficiaries for Whom Colorado Made Medicaid Payments Met Federal and State Requirements, but Documentation Supporting That All Eligibility Requirements Were Verified Properly Was Not Always in Place A-07-18-02812
03-23-2020: Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers A-04-18-07080
03-17-2020: CMS Could Take Actions To Help States Comply With Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions A-09-18-02004
03-13-2020: Missouri Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-18-03230
03-06-2020: Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-18-08065
03-03-2020: Factsheet: Kentucky's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-02022
03-02-2020: Medicare Hospital Provider Compliance Audit: Saint Francis Health Center A-07-17-05102
02-28-2020: The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act A-03-16-03001
02-25-2020: CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments A-06-16-01002
02-20-2020: New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers A-02-18-01020
02-19-2020: New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-02-18-01011
02-14-2020: Michigan Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-05-17-00048
02-11-2020: The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes A-05-17-00020
02-07-2020: The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs A-09-18-01000
02-06-2020: New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option A-02-17-01015
02-06-2020: Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes A-06-19-08001
02-04-2020: New York Claimed Tens of Millions of Dollars for Opioid Treatment Program Services That Did Not Comply With Medicaid Requirements Intended To Ensure the Quality of Care Provided to Beneficiaries A-02-17-01021; 01-29-2020; The Indiana State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-05-19-00007
01-24-2020: More Than One-Third of New Jersey's Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable A-02-17-01020
01-21-2020: CMS's Implementation of a 2014 Policy Change Resulted in Improvements in the Reporting of Coverage Gap Discounts Under Medicare Part D A-07-16-06067
01-17-2020: Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-03-17-00202
01-13-2020: CMS's Controls Over Assigning Medicare Beneficiary Identifiers and Mailing New Medicare Cards Were Generally Effective but Could Be Improved in Some Areas A-09-19-03003
01-09-2020: New York Improperly Claimed Medicaid Reimbursement for Some Bridges to Health Waiver Program Services That Were Not in Accordance With an Approved Plan of Care and Did Not Meet Documentation Requirements A-02-18-01003