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Florida Medicaid Fraud Control Unit: 2025 Inspection

Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees

CMS’s Processes Were Not Effective in Ensuring the Accuracy of Staffing Information Reported in the Payroll-Based Journal

Jefferson Regional Medical Center Received at Least $4.7 Million in Medicare Overpayments

North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings

A Small Southeastern Hospital Had Effective Cybersecurity Controls To Prevent, Detect, and Respond To Cyberattacks

Inaccurate Medicaid Managed Care Provider Directories May Limit Enrollees’ Access to Maternal Health Care

Inaccurate Medicaid Managed Care Network Lists May Compromise State Oversight of Access to Maternal Health Care

Congressional Mandate: Part B Billing Codes for Six Drugs Included Noncovered Self-Administered Versions During January 2025 - March 2026

The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates

Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials

California Made at Least $13.9 Million More in Medicaid Reimbursements for Clinical Diagnostic Laboratory Services Than Was Allowed by Federal and State Requirements

Community Behavioral Health Did Not Comply With Requirements When Denying Prior Authorization Requests

The Office of Refugee Resettlement Needs To Improve Its Monitoring of Unlicensed Unaccompanied Alien Children Program Care Providers’ Compliance With Background Check Requirements

Lehigh Valley Hospital Received At Least $17.8 Million in Medicare Overpayments

CMS Should Improve Its Policies and Procedures for the Oversight of States’ Reported Medicaid Expenditures to Better Protect the Financial Integrity of the Medicaid Program

CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes

Connecticut Did Not Always Ensure Selected Nursing Homes Complied With Federal and State Background Check Requirements

Impacts of Vertical Integration in Medicare Part D on Sponsors’ Drug Costs, Pharmacy Reimbursement, and Enrollee Cost Sharing

Unclear Medicare Requirements Led to Differing Interpretations of Inpatient Rehabilitation Facility Documentation, Coverage, and Billing Requirements

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