Skip to main content

What's New

See also: Archive

November 2024

11-29-2024: Texas Generally Claimed Medicaid Reimbursement for Fee-for-Service Inpatient Hospital Claims With Malnutrition Diagnosis Codes in Accordance with Federal and State Requirements�A-06-22-04002; Selected Home Health Agencies Complied With Terms and Conditions and Federal Requirements for Provider Relief Fund Payments�A-01-22-00503
11-27-2024: Puerto Rico Did Not Designate a Medicaid Contracts Oversight Lead in a Timely Manner and Certified Contracts That Were Noncompliant� A-02-24-01002
11-26-2024: CDC's and SAMHSA's Processes for and Challenges With Compiling Data for the National Drug Control Assessment�A-03-24-00353
11-25-2024: The Office for Civil Rights Should Enhance Its HIPAA Audit Program to Enforce HIPAA Requirements and Improve the Protection of Electronic Protected Health Information�A-18-21-08014; Advisory Opinion 24-09 Favorable opinion regarding: a proposal for a municipal corporation to begin billing patients' insurance plans—and waiving any patient cost-sharing amounts—for treatment-in-place emergency medical services without an associated ambulance transport.
11-20-2024: Nursing Facility Industry Segment-Specific Compliance Program Guidance
11-19-2024: Review of the Department of Health and Human Services' Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2024�A-18-24-11200
11-18-2024: 2024 Top Management & Performance Challenges Facing HHS; Medicare Improperly Paid Acute-Care Hospitals an Estimated $190 Million Over 5 Years for Outpatient Services Provided to Hospice Enrollees�A-09-23-03024; Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2024�OEI-03-25-00010; Job Opening: FOIA General Attorney (Associate Counsel)
11-15-2024: Updated: Work Plan; Updated: Corporate Integrity Agreements; Washington State's Oversight Could Better Ensure That Adult Family Homes Comply With Health and Safety and Administrative Requirements�A-09-23-02002; Utah Generally Operated Its Medicaid Estate Recovery Program in Accordance With Requirements and in a Cost Effective Manner, but Utah Did Not Have Formal Written Procedures�A-07-23-03257
11-14-2024: Maine Did Not Comply With Screening, Assessment, and Investigation Requirements for Responding to Reports of Child Abuse and Neglect�A-01-23-02500; Seven of Thirty Hospices Reviewed Did Not Comply or May Not Have Complied With Terms and Conditions and Federal Requirements for Provider Relief Fund Payments�A-02-22-01014; National Government Services, Inc., Reopened and Corrected Cost Report Final Settlements With Obvious Errors To Collect Overpayments Made to Medicare Providers�A-06-24-05000; Updated: Heightened Scrutiny
11-13-2024: Findings of Retaliation by Management Official in the HHS Office of the Chief Information Officer
11-08-2024: LEIE Database Updated with October 2024 Exclusions and Reinstatements; Not All Selected Hospitals Complied With the Hospital Price Transparency Rule�A-07-22-06108; Updated: CMP and Affirmative Exclusions; Updated: Fraud Self-Disclosures
11-07-2024: National Background Check Program for Long-Term Care Providers: A Final Assessment�OEI-07-24-00100; Updated: Corporate Integrity Agreements
11-01-2024: Updated: CMP and Affirmative Exclusions, EMTALA/Patient Dumping

October 2024

10-31-2024: Job Opening: Administrative and Civil Remedies Branch (ACRB) and Industry Guidance Branch (IGB) Attorney; Updated: Corporate Integrity Agreements
10-29-2024: ASPR Established Adequate Controls for Maintaining Physical Security and Inventory Records at Stockpile Site B�A-04-24-02046
10-25-2024: California Used CARES Act Funds for Unallowable Nutrition Services Program Expenditures�A-06-22-01004; Massachusetts Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety and Emergency Preparedness�A-01-24-00001
10-24-2024: Medicare Advantage: Plans Still Using Questionable Health Risk Assessments to Boost Medicare Payments by Billions�OEI-03-23-00380
10-22-2024: Medicare Part D Paid Millions for Drugs for Which Payment Was Available Under the Medicare Part A Skilled Nursing Facility Benefit�A-09-21-03008; Updated: CMP and Affirmative Exclusions
10-17-2024: 2024 Top Unimplemented Recommendations
10-16-2024: Employee Profile: Kofi Ansah-Brew
10-15-2024: Updated: Work Plan
10-11-2024: Updated: Fraud Risk and Heightened Scrutiny Q1-Q4; Updated: Annual Inflation Updates to the Annual Cap on Patient Engagement Tools and Supports Under 42 CFR § 1001.952(hh)
10-10-2024: HHS-OIG: Strengthening Cybersecurity in Health Care; LEIE Database Updated with September 2024 Exclusions and Reinstatements; Finding of Retaliation by Administration Children and Families Grantee
10-09-2024: Massachusetts Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control�A-01-23-00003
10-08-2024: Updated: Fraud Self-Disclosures
10-04-2024: HHS Continues to Make Progress Toward Compliance With the Geospatial Data Act�A-18-24-03500; Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2023�A-18-24-11300
10-03-2024: New Strategic Plan: Safeguarding the Integrity of HHS Grants and Contracts
10-02-2024: States Could Better Leverage Coverage and Access Requirements To Promote Maternal Health Care Access in Medicaid Managed Care�OEI-05-22-00330

September 2024

09-30-2024: ASPR Established Adequate Controls for Maintaining Physical Security Over Stockpile Site A, but Some Inventory Discrepancies Were Identified�A-04-24-02044
09-27-2024: Featured Article: HHS-OIG's Efforts to Address the Opioid Epidemic
09-26-2024: Gallup Indian Medical Center—an IHS-Operated Health Facility—Did Not Timely Conduct Required Background Checks of Staff and Supervise Certain Staff�A-02-23-02006; Medicare Advantage Compliance Audit of Diagnosis Codes That EmblemHealth (Contract H3330) Submitted to CMS�A-06-18-02001
09-25-2024: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Humana Health Plan, Inc. (Contract H2649) Submitted to CMS�A-02-22-01001; Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HealthAssurance, Pennsylvania, Inc. (Contract H5522) Submitted to CMS�A-05-22-00020
09-24-2024: Additional Oversight of Remote Patient Monitoring in Medicare Is Needed�OEI-02-23-00260; Systemic and Operational Challenges Hinder Efforts to Ensure HIV Care for Medicaid Enrollees�OEI-05-22-00242
09-23-2024: Medicare and Medicaid Enrollees in Many High-Need Areas May Lack Access to Medications for Opioid Use Disorder�OEI-BL-23-00160
09-19-2024: CMS Recovered Medicare Payments to Providers Under the COVID-19 Accelerated and Advance Payments Program in Compliance With Federal Requirements�A-05-23-00005
09-18-2024: Revised Medicaid Fraud Control Unit Performance Standards
09-17-2024: Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2022 Average Sales Prices�OEI-03-24-00080
09-16-2024: Updated: Work Plan
09-13-2024: Novitas Solutions, Inc., Reopened and Corrected Cost Report Final Settlements With Obvious Errors To Collect Overpayments Made to Medicare Providers�A-06-23-05001; Advisory Opinion 24-08 Unfavorable advisory opinion regarding an entity's proposal to share a percentage of its savings with certain groups to which it provides coverage through Employer Group Waiver Plans.
09-12-2024: Updated: Corporate Integrity Agreements
09-11-2024: Featured Topic: The Emergency Medical Treatment and Labor Act (EMTALA); Updated: Fraud Self-Disclosures; Spring 2025 OIG Health Care Fraud and Abuse Legal Internship
09-10-2024: Most Children in Foster Care Did Not Receive Credit Checks and Assistance�OEI-07-22-00510; LEIE Database Updated with August 2024 Exclusions and Reinstatements
09-09-2024: Employee Profile: Amanda Sutter
09-05-2024: New Mexico Did Not Ensure Attendants Were Qualified To Provide Personal Care Services, Putting Medicaid Enrollees at Risk�A-06-22-02000
09-03-2024: Massachusetts Opioid Treatment Program Services Met Many of the Federal and State Requirements�A-01-23-00002
08-29-2024: South Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations�A-07-22-07010; Utah Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements�A-07-24-07013
08-23-2024: Advisory Opinion 24-07 Favorable opinion regarding a proposed patient assistance program operated by a nonprofit grant-making organization.
08-21-2024: Kansas's Implemented Electronic Visit Verification System Could Be Improved�A-07-23-03255
08-20-2024: Certain For-Profit Nursing Homes May Not Have Complied With Federal Requirements Regarding the Infection Preventionist Position�A-01-22-00001
08-19-2024: Illinois MMIS and E&E System Had Adequate Security Controls in Place, but Some Improvements Are Needed�A-18-22-09009
08-16-2024: Updated: Corporate Integrity Agreements; Updated: CMP and Affirmative Exclusions
08-15-2024: Updated: Work Plan; Massachusetts Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements�A-02-24-01001
08-14-2024: Medicare Advantage Compliance Audit of Diagnosis Codes That MMM Healthcare, LLC, (Contract H4003) Submitted to CMS�A-04-20-07090
08-13-2024: Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2024�OEI-03-24-00070; Office of Inspector General's Partnership With the Ohio Auditor of State: Auditor of State's Report Ohio Department of Medicaid: The Cost of Concurrent Enrollment�A-09-23-02004
08-12-2024: Medicare Improperly Paid Hospitals an Estimated $79 Million for Enrollees Who Had Received Mechanical Ventilation�A-09-22-03002; Updated: Fraud Self-Disclosures
08-09-2024: Medicare and Some Enrollees Paid Substantially More When Stelara Was Covered Under Part D Versus Part B�OEI-BL-19-00500; LEIE Database Updated with July 2024 Exclusions and Reinstatements
08-07-2024: Opioid Treatment Programs in Washington State Did Not Fully Comply With Federal and State Requirements, Which May Have Put Medicaid Enrollees at Risk for Poor Treatment Outcomes�A-09-21-02001; Updated: Corporate Integrity Agreements
08-05-2024: CDC Provided Oversight and Assistance, but Recipients Faced Challenges in Implementing a COVID-19 Vaccine Confidence Strategy�A-06-22-04004; The National Institutes of Health Administered Superfund Appropriations During Fiscal Year 2023 in Accordance With Federal Requirements�A-04-24-02045
08-02-2024: Alaska Medicaid Fraud Control Unit: 2023 Inspection�OEI-07-23-00240
07-31-2024: Updated: Fraud Risk and Heightened Scrutiny Q1-Q3
07-29-2024: Employee Profile: Melissa C. Tucker; West Virginia Medicaid Fraud Control Unit: 2023 Inspection�OEI-09-23-00390; Heluna Health May Not Have Used California's CDC COVID-19 Funds in Accordance With Award Requirements�A-04-22-02037
07-26-2024: California Made Capitation Payments for Enrollees Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Another State�A-05-23-00008
07-23-2024: Advisory Opinion 24-06 Unfavorable opinion regarding proposed assistance for fertility services for qualifying patients receiving a gene therapy treatment developed by a biotechnology company.
07-22-2024: Advisory Opinion 24-05 Favorable in part and unfavorable in part opinion regarding proposed assistance for: (i) travel, lodging, meals, and associated expenses; and (ii) fertility preservation services for qualifying patients receiving one of two gene therapy treatments developed by a publicly traded biotechnology company.; HHS Office of the Secretary Needs to Improve Key Security Controls to Better Protect Certain Cloud Information Systems�A-18-22-08018; Updated: Corporate Integrity Agreements
07-16-2024: Job Opening: Schedule A Persons with Disability Opportunity: Criminal Investigator GL-1811-09 (Closes July 22); ASPR Did Not Consistently Comply With Federal Requirements for Awarding Research and Development Contracts�A-03-20-03003; Updated: Corporate Integrity Agreements
07-15-2024: Updated: Work Plan
07-12-2024: Updated: Corporate Integrity Agreements
07-11-2024: Updated: Corporate Integrity Agreements
07-10-2024: LEIE Database Updated with June 2024 Exclusions and Reinstatements
07-08-2024: NEW HHS-OIG Impact Brief: Medicare Advantage Fraud; Updated FAQ: General Questions Regarding Certain Fraud and Abuse Authorities
07-05-2024: Updated: Fraud Self-Disclosures; Updated: Grant and Contractor Fraud Self-Disclosures
07-02-2024: 2023 Performance Data for the Senior Medicare Patrol Projects�OEI-02-24-00260
07-01-2024: Updated: CMP and Affirmative Exclusions
06-28-2024: Part D Plans Generally Include Drugs Commonly Used by Dual-Eligible Enrollees: 2024�OEI-05-24-00210; Review of the Department of Health and Human Services' Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2023�A-18-23-11200
06-27-2024: 2024 Nationwide Health Care Fraud Enforcement Action; The National Institutes of Health Has Made Progress But Could Further Improve Its Closeout Process for Grants and Similar Awards�A-04-23-08097; Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Independent Health Association, Inc. (Contract H3362) Submitted to CMS�A-07-19-01194
06-26-2024: Many States Lack Information To Monitor Maltreatment in Residential Facilities for Children in Foster Care�OEI-07-22-00530
06-25-2024: North Carolina Did Not Report and Return All Medicaid Overpayments for the State's Medicaid Fraud Control Unit Cases�A-06-23-04004
06-20-2024: NIH Did Not Close Contracts in Accordance With Federal Requirements, Resulting in the Increased Risk of Fraud, Waste, and Abuse�A-04-23-03585; Advisory Opinion 24-04 Favorable opinion regarding: (i) a limited-time program to refund, waive, or delay requiring receipt of payment for a drug in the event of an insurance reimbursement denial or delay; and (ii) certain discounts to the cost of the drug.
06-18-2024: Updated: Corporate Integrity Agreements
06-17-2024: Updated: Work Plan; Advisory Opinion 24-03 Favorable opinion regarding assistance, including travel, lodging, meals, and associated expenses, provided by a pharmaceutical manufacturer to qualifying patients receiving its gene therapy product and their caregivers.
06-13-2024: The Food and Drug Administration's Inspection and Recall Process Should Be Improved To Ensure the Safety of the Infant Formula Supply�A-01-22-01502; CMS Could Strengthen Program Safeguards To Prevent and Detect Improper Medicare Payments for Short Inpatient Stays�A-09-21-03022
06-11-2024: Updated: Corporate Integrity Agreements
06-10-2024: LEIE Database Updated with May 2024 Exclusions and Reinstatements; Washington Medicaid Fraud Control Unit: 2023 Inspection�OEI-09-23-00230
06-07-2024: Updated: Fraud Self-Disclosures
06-04-2024: Updated: Corporate Integrity Agreements
06-03-2024: Spring 2024 Semiannual Report to Congress; HHS-OIG Reports Nearly $3 Billion in Expected Recoveries in Newly Streamlined Semiannual Report; OpEd: Pandemic lessons must spur federal action to protect nursing home residents
05-30-2024: Fall 2024 OIG Health Care Fraud and Abuse Legal Internship
05-29-2024: Medicare Remains Vulnerable to Fraud, Waste, and Abuse Related to Off-the-Shelf Orthotic Braces, Which May Result in Improper Payments and Impact the Health of Enrollees�A-09-21-03019
05-28-2024: Plans and Enrollment Often Fell Short for Underrepresented Groups in a Sample of NIH-Funded Clinical Trials�OEI-01-21-00320
05-23-2024: Medicaid Managed Care: States Do Not Consistently Define or Validate Paid Amount Data for Drug Claims�OEI-03-20-00560
05-22-2024: Wanted Fugitive: Dr. Yogeshwar Singh "Garry" Gill; Selected CDC Racial and Ethnic Approaches to Community Health Program Recipients Generally Complied With Federal Requirements But Did Not Meet All Targets and Charged Some Unallowable Costs�A-02-22-02001
05-21-2024: California Improperly Claimed $52.7 Million in Federal Medicaid Reimbursement for Capitation Payments Made on Behalf of Noncitizens With Unsatisfactory Immigration Status�A-09-22-02004
05-20-2024: Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for the Fiscal Year 2023�A-17-24-52000; Updated: Corporate Integrity Agreements; Office of Counsel Job Opening: Special Policy Advisor/Reviewing Official
05-16-2024: Employee Profile: Deputy Regional Inspector General Meridith Seife: Creative Problem Solving to Make Meaningful, Positive Change in People's Lives; Updated: Corporate Integrity Agreements
05-15-2024: Updated: Work Plan; Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for Some Cases Identified by the State's Program Integrity Section�A-07-19-02816
05-14-2024: New York Medical College Claimed Unallowable Grant Costs and Did Not Meet Certain Financial Conflict of Interest Requirements�A-04-20-03583; Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2023�OEI-03-24-00060
05-13-2024: New Mexico Should Refund Almost $120 Million to the Federal Government for Medicaid Nursing Facility Level-of-Care Managed Care Capitated Payments�A-06-20-09001; Updated: CMP and Affirmative Exclusions
05-10-2024: LEIE Database Updated with April 2024 Exclusions and Reinstatements; Potential Vulnerabilities in CMS Oversight of Medicare Add-on Payments for COVID-19 Tests Show That Oversight of Incentive Payments Could Be Improved�A-09-22-03015; State Agencies Could Be Obtaining Hundreds of Millions in Additional Medicaid Rebates Associated With Physician-Administered Drugs�A-07-23-06111
05-09-2024: California Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements�A-09-24-02001; Updated: Corporate Integrity Agreements
05-08-2024: Survey on the Role of Patient Selection Criteria in Ensuring Equitable Access to Kidney Transplantation; Updated: Fraud Self-Disclosures; Updated: Corporate Integrity Agreements
05-07-2024: Office of Inspector General's Partnership With the State of Rhode Island, Office of the Auditor General: Medicaid Capitation Paid for Members Residing in Other States�A-01-23-00001
05-02-2024: Medicaid Enrollees May Not Be Screened for Intimate Partner Violence Because of Challenges Reported by Primary Care Clinicians�OEI-03-21-00310
05-01-2024: Updated: FY 2024 Q1-Q2 False Claims Act Settlements on the Risk Spectrum