Show CMS Document Archive 202209-30-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract R5826) Submitted to CMS A-05-19-0003909-29-2022Texas 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-03-19-0000109-28-2022Medicare Dialysis Services Provider Compliance Audit - Dialysis Clinic, Inc. A-05-20-0001009-29-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That BlueCross BlueShield of Tennessee, Inc. (Contract H7917) Submitted to CMS A-07-19-0119509-26-2022Medicare Advantage Compliance Audit of Diagnosis Codes That Inter Valley Health Plan, Inc. (Contract H0545), Submitted to CMS A-05-18-0002009-23-2022Medicare Hospice Provider Compliance Audit: Hospice of Palm Beach County, Inc. A-02-20-0100109-22-2022CMS'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 09-21-2022End-Stage Renal Disease Network Organizations' Reported Actions Taken in Response to the COVID-19 Pandemic A-05-20-0005109-20-2022New York Generally Determined Eligibility for Its Basic Health Program Enrollees in Accordance With Program Requirements A-02-20-01028 09-19-2022Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States A-05-20-00025Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services A-06-21-0500309-15-2022Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-0000409-14-2022Tennessee Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-21-0609609-13-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Regence BlueCross BlueShield of Oregon (Contract H3817) Submitted to CMS A-09-20-0300909-12-2022New 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-02-21-0100108-29-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That WellCare of Florida, Inc., (Contract H1032) Submitted to CMS A-04-19-0708408-26-2022Montana Claimed Federal Medicaid Reimbursement for More Than $5 Million in Targeted Case Management Services That Did Not Comply With Federal and State Requirements A-07-21-0324608-19-2022Medicare Advantage Compliance Audit of Diagnosis Codes That Cigna HealthSpring of Florida, Inc. (Contract H5410) Submitted to CMS A-03-18-0000208-10-2022South Carolina Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-21-0700307-27-2022 Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2021 A-18-22-1130007-26-2022Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness A-01-20-00005 07-25-2022CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits A-04-18-0308507-19-2022Medicare Critical Care Services Provider Compliance Audit: Lahey Clinic, Inc. A-03-20-0000207-18-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cariten Health Plan, Inc., (Contract H4461) Submitted to CMS A-02-20-01009 07-15-2022Audits 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-02-21-0101007-14-2022Medicare Hospice Provider Compliance Audit: Vitas Healthcare Corporation of Florida A-02-19-0101807-05-2022The Reduced Outlier Threshold Applied to Transfer Claims Did Not Significantly Increase Medicare Payments to Hospitals A-05-19-0001906-29-2022The Centers for Medicare & Medicaid Services Had Policies and Procedures in Place To Mitigate Vulnerabilities in a Timely Manner, but Improvements Are Needed A-18-20-0650006-23-2022More 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-01-20-00006An 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-09-22-0200306-10-2022Medicare 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-07-18-0281506-06-2022Maine Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-0000705-25-2022Texas 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-06-18-05002Vanderbilt University Medical Center: Audit of Outpatient Outlier Payments A-06-20-0400305-31-2022Medicare Improperly Paid Durable Medical Equipment Suppliers an Estimated $8 Million of the $40 Million Paid for Power Mobility Device Repairs A-09-20-0301605-24-2022Selected Dialysis Companies Implemented Additional Infection Control Policies and Procedures To Protect Beneficiaries and Employees During the COVID-19 Pandemic A-05-20-0005205-13-2022Washington State Did Not Comply With Federal and State Requirements for Claiming Enhanced Federal Reimbursement for Medicaid Managed-Care Health Home Service Expenditures A-09-20-0200804-25-2022Massachusetts Implemented Our Prior Audit Recommendations and Generally Complied With Federal and State Requirements for Reporting and Monitoring Critical Incidents A-01-20-0000304-20-2022California Improperly Claimed at Least $23 Million of $260 Million in Total Medicaid Reimbursement for Opioid Treatment Program Services A-09-20-0200904-07-2022Posthospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries in Indiana Generally Met Medicare Level-of-Care Requirements A-05-20-0000504-01-2022South Carolina Did Not Fully Comply With Requirements for Reporting and Monitoring Critical Events Involving Medicaid Beneficiaries With Developmental Disabilities A-04-18-0707803-29-2022Psychotherapy Services Billed by a New York City Provider Did Not Comply With Medicare Requirements A-02-21-0100603-14-2022New 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-06-19-0900503-08-2022New Jersey's Medicaid School-Based Cost Settlement Process Could Result in Claims That Do Not Meet Federal Requirements A-02-20-0101203-02-2022The Centers for Medicare & Medicaid Services' Eligibility Review Contractor Adequately Determined Medicaid Eligibility for Selected States Under the Payment Error Rate Measurement Program A-02-20-0100602-22-2022Hospitals Did Not Always Meet Differing Medicare Contractor Specifications for Bariatric Surgery A-09-20-0300702-18-2022Office 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-09-22-0200102-15-2022New 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-02-19-0101702-14-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Tufts Health Plan (Contract H2256) Submitted to CMS A-01-19-00500Medicare 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-09-20-0301502-03-2022Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan (Contract H5425) Submitted to CMS A-07-17-0116902-01-2022Prior Audits of Medicaid Eligibility Determinations in Four States Identified Millions of Beneficiaries Who Did Not or May Not Have Met Eligibility Requirements A-02-20-0101801-24-2022Independent 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-03-22-0035101-05-2022Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Healthfirst Health Plan, Inc., (Contract H3359) Submitted to CMS A-02-18-0102901-04-2022Noridian 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-07-21-00603Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2014 Through 2016 A-07-21-00602Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals for Calendar Years 2014 Through 2016 A-07-21-00605Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Postretirement Benefit Assets as of January 1, 2017 A-07-21-00604202112-22-2021Arkansas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-0100312-16-2021Trends in Genetic Tests Provided Under Medicare Part B Indicate Areas of Possible Concern A-09-20-03027Medicare Hospital Provider Compliance Audit: St. Joseph's Hospital Health Center A-02-20-0100412-07-2021Medicare 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-01-20-0050112-03-2021Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation Sessions A-09-21-0300212-02-2021Kentucky Made Almost $2 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Medicaid ID Numbers A-04-20-0709411-22-2021CMS Should Strengthen Its Prescription Drug Event Guidance To Clarify Reporting of Sponsor Margin for Medicare Part D Bids A-03-17-0000111-17-2021Missouri Properly Converted Provisionally Enrolled Medicaid Providers to Permanent Providers A-07-21-0324811-16-2021Medicare Improperly Paid Suppliers an Estimated $117 Million Over 4 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Hospice Beneficiaries A-09-20-0302611-05-2021Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UPMC Health Plan, Inc. (Contract H3907) Submitted to CMS A-07-19-0118810-28-2021Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health Care of Missouri, Inc. (Contract H2663) Submitted to CMS A-07-17-0117310-25-2021Office 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-01-20-0000110-21-2021Michigan Did Not Report Calendar Year 2019 Medicaid Third-Party Liability Cost Avoidance Data to the Centers for Medicare & Medicaid Services A-05-20-0005810-19-2021Tennessee Medicaid Claimed Hundreds of Millions of Federal Funds for Certified Public Expenditures That Were Not in Compliance With Federal Requirements A-04-19-0407010-13-2021Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic A-06-20-04007 10-01-2021Medicare Overpaid $636 Million for Neurostimulator Implantation Surgeries A-01-18-0050009-24-2021Six 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-01-20-0050809-22-2021California Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-09-19-0200409-21-2021About Seventy-Nine Percent of Opioid Treatment Program Services Provided to Medicaid Beneficiaries in Colorado Did Not Meet Federal and State Requirements A-07-20-0411809-20-2021Minnesota Medicaid Managed Care Entities Used a Majority of Medicaid Funds Received for Medical Expenses and Quality Improvement Activities A-05-18-0001809-08-2021Colorado Did Not Invoice Rebates to Manufacturers for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-07-17-0607509-07-2021An Ophthalmology Clinic in Florida: Audit of Medicare Payments for Eye Injections of Avastin, Eylea, and Lucentis A-09-19-0302509-01-2021CMS'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-09-20-02005Kansas Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-07-20-0512508-25-2021CGS Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00613CMS Needs To Issue Regulations Related to Phlebotomy Travel Allowances A-06-20-04000CGS Administrators, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-0061208-18-2021Medicare Home Health Agency Provider Compliance Audit: Catholic Home Care A-02-19-01013Medicare Hospital Provider Compliance Audit: Jewish Hospital A-04-19-08077CGS Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-00593CGS Administrators, LLC, Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan III Costs Through Its Incurred Cost Proposals A-07-21-0060808-13-2021Medicare Paid New Hospitals Three Times More for Their Capital Costs Than They Would Have Been Paid Under the Inpatient Prospective Payment System A-07-19-0281808-12-2021Oklahoma's Oversight of Medicaid Outpatient Services for Opioid Use Disorder Was Generally Effective A-06-20-08000Missouri Claimed Federal Reimbursement for $3.4 Million in Payments to Health Home Providers That Did Not Meet Medicaid Requirements A-07-20-0411708-10-2021Palmetto 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-07-21-00615Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00614Companion Data Services, LLC, Supplemental Executive Retirement Plan III Costs Claimed Through Incurred Cost Proposals Were Allowable and Reasonable A-07-21-00611Companion Data Services, LLC, Claimed Some Unallowable Medicare Excess Plan Costs Through Its Incurred Cost Proposals A-07-21-00610Companion Data Services, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-21-00609Palmetto Government Benefits Administrator, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-20-0059208-06-2021Almost All of the Medicare Pension Costs That Companion Data Services, LLC, Claimed Through Its Incurred Cost Proposals Were Allowable A-07-20-00594Medicare Continues To Make Overpayments for Chronic Care Management Services, Costing the Program and Its Beneficiaries Millions of Dollars A-07-19-0512207-28-2021Almost 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 07-21-2021Texas Made Unallowable Children's Health Insurance Program Payments for Beneficiaries Assigned More Than One Identification Number A-06-20-1000307-20-2021Palmetto 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-02-18-0101907-12-2021Review 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-03-19-00002Medicare Hospice Provider Compliance Audit: Partners In Care, Inc. A-09-18-0302407-08-2021Medicare Hospice Provider Compliance Audit: Mission Hospice & Home Care, Inc. A-09-18-03009The Centers for Medicare & Medicaid Services Did Not Account for National Security Risks in Its Enterprise Risk Management Processes A-18-20-0620007-07-2021Medicare Payments for Transitional Care Management Services Generally Complied With Federal Requirements, but Some Overpayments Were Made A-07-17-05100New 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-02-19-0100706-30-2021Indiana Received Over $22 Million in Excess Federal Funds Related to Unsupported Community Integration and Habilitation Waiver Services at 12 Selected Service Providers A-05-19-00022Medicare Hospital Provider Compliance Audit: Lake Hospital System A-05-19-0002406-24-2021CMS'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-02-21-01003Medicare Hospital Provider Compliance Audit: Staten Island University Hospital A-02-18-01025Kentucky Claimed Millions in Unallowable School-Based Medicaid Administrative Costs A-04-17-0011306-23-2021Medicare Hospice Provider Compliance Audit: Northwest Hospice, LLC A-09-20-03035 06-10-2021Nebraska 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-07-18-02814Medicare Hospice Provider Compliance Audit: Professional Healthcare at Home, LLC A-09-18-03028 06-09-2021California 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-09-19-0200506-08-2021Opportunities Exist for CMS and Its Medicare Contractors To Strengthen Program Safeguards To Prevent and Detect Improper Payments for Drug Testing Services A-09-20-0301706-03-2021University of Michigan Health System: Audit of Medicare Payments for Polysomnography Services A-04-20-0708806-02-2021New Mexico Did Not Bill Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-06-16-0000105-28-2021Medicare Home Health Agency Provider Compliance Audit: Caretenders of Jacksonville, LLC A-04-16-0619505-25-2021Blue Cross Blue Shield of South Carolina Overstated Its Excess Plan Partial Medicare Segment Pension Assets as of January 1, 2017 A-07-21-0060705-24-2021Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments A-07-19-0511705-21-2021 Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Anthem Community Insurance Company, Inc. (Contract H3655) Submitted to CMS A-07-19-0118705-20-2021Sleep Management, LLC: Audit of Claims for Monthly Rental of Noninvasive Home Ventilators A-04-18-04066 05-18-2021Medicare Hospice Provider Compliance Audit: Franciscan Hospice A-09-20-0303405-14-2021Medicare Hospice Provider Compliance Audit: Alive Hospice, Inc. A-09-18-03016Medicare Hospice Provider Compliance Audit: Ambercare Hospice, Inc. A-09-18-0301705-13-2021CMS 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 05-11-2021New 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-02-20-01007Medicare 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-09-19-0302705-07-2021Medicare Hospice Provider Compliance Audit: Suncoast Hospice A-02-18-0100105-06-2021Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-0003205-05-2021Louisiana Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-0200505-04-2021Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital A-02-18-0101804-27-2021Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Maryland A-03-17-0000904-21-2021Office 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-02-21-0100804-19-2021Medicare Advantage Compliance Audit of Diagnosis Codes That Humana, Inc., (Contract H1036) Submitted to CMS A-07-16-0116504-12-2021Georgia Generally Ensured That Nursing Facilities Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Prioritized Allegations Timely A-04-17-0308404-08-2021Blue Cross Blue Shield of South Carolina Overstated Its Supplemental Executive Retirement Plan III Medicare Allowable Segment Pension Assets as of January 1, 2017 A-07-20-0060004-08-2021Palmetto Government Benefits Administrator, LLC, Overstated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-20-0059804-07-2021Noridian Healthcare Solutions, LLC, Claimed Unallowable Medicare Nonqualified Restoration Savings Plan Costs Through Its Incurred Cost Proposals A-07-20-0059103-31-2021Medicare Hospital Provider Compliance Audit: Sunrise Hospital & Medical Center A-04-19-0807503-29-2021 Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds A-06-19-0200003-23-2021Companion Data Services, LLC, Properly Updated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017 A-07-21-0060603-29-2021An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis A-09-19-0302203-17-2021North Mississippi Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-0708603-04-2021Peninsula Regional Medical Center: Audit of Medicare Payments for Polysomnography Services A-04-19-07087Florida 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-04-17-0805803-01-2021CMS Authorized Hundreds of Millions of Dollars in Advanced Premium Tax Credits on Behalf of Enrollees Who Did Not Make Their Required Premium Payments A-02-19-0200502-25-2021Medicare Home Health Agency Provider Compliance Audit: Brookdale Home Health, LLC A-04-18-0622102-24-2021Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross Blue Shield of Michigan (Contract H9572) Submitted to CMS A-02-18-0102802-22-2021Medicare Hospice Provider Compliance Audit: Tidewell Hospice, Inc. A-02-18-0102402-19-2021Noridian Healthcare Solutions, LLC, Made Improper Medicare Payments of $4 Million to Physicians in Jurisdiction E for Spinal Facet-Joint Injections A-09-20-0301002-16-2021New York Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-02-17-01026Iowa Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-19-0323802-03-2021Illinois Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-0003101-27-2021Louisiana Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-06-18-0200001-25-2021 California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider's Opioid Treatment Program Services A-09-20-0200101-21-2021Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program A-01-19-00004 01-15-2021CMS and Its Contractors Did Not Use Comprehensive Error Rate Testing Program Data To Identify and Focus on Error-Prone Providers A-05-17-0002301-13-2021Medicare Home Health Agency Provider Compliance Audit: Southeastern Home Health Services A-03-17-00004202012-30-2020The Centers for Medicare & Medicaid Services Could Improve Its Wage Index Adjustment for Hospitals in Areas With the Lowest Wages 12-22-2020Medicare Home Health Agency Provider Compliance Audit: Tender Touch Health Care Services A-04-18-07077 12-21-2020Aspects of Texas' Quality Incentive Payment Program Raise Questions About Its Ability To Promote Economy and Efficiency in the Medicaid Program A-06-18-0700112-16-2020Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Tullahoma, Tennessee A-02-16-01024 12-16-2020Medicare Hospital Provider Compliance Audit: Providence Medical Center A-07-18-0511312-11-2020Risk Assessment Puerto Rico Medicaid Program A-02-20-0101112-09-2020New York Improved Its Monitoring of Its Personal Care Services Program But Still Made Improper Medicaid Payments of More Than $54 Million A-02-19-0101612-07-2020Medicare Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC A-06-16-0500512-01-2020 Nebraska Claimed Almost All Medicaid Payments for Targeted Case Management Services in Accordance With Federal Requirements but Claimed Some Unallowable Duplicate Payments A-07-19-0323911-24-2020Florida Received Unallowable Medicaid Reimbursement for School-Based Services A-04-18-07075 11-19-2020Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Payson, Arizona. A-02-16-0102311-18-2020Medicare Home Health Agency Provider Compliance Audit: The Palace at Home A-04-17-0706711-17-2020Cahaba Government Benefits Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00577Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00578 11-16-2020Hospitals Did Not Comply With Medicare Requirements for Reporting Cardiac Device Credits A-01-18-0050211-12-2020Ohio 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-05-18-0004511-10-2020Ohio Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-05-18-0002711-05-2020Cahaba Government Benefits Administrators, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00575Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00576 11-04-2020CMS 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-07-19-0056010-29-2020Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc. A-02-17-0102510-22-2020Massachusetts Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-06-18-0400110-21-2020Minnesota Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00018 10-16-2020Medicare Home Health Agency Provider Compliance Audit: Gem City Home Care, LLC A-05-18-00011Medicare Hospital Provider Compliance Audit: St Francis Hospital A-05-18-00048 10-14-2020Cedars-Sinai Medical Center: Audit of Medicare Payments for Bariatric Surgeries A-09-18-0301010-09-2020Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period A-09-20-0300310-07-2020Update on Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic A-09-20-0100010-02-2020Colorado Improperly Claimed Millions in Enhanced Federal Medicaid Reimbursement for New Adult Group Beneficiaries Because of a Data Processing Error A-07-17-02807Medicare Critical Care Services Provider Compliance Audit: Clinical Practices of the University of Pennsylvania A-03-18-0000309-30-2020Medicare Hospital Provider Compliance Audit: Alta Bates Summit Medical Center A-04-19-0807109-25-2020North Carolina Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-04-16-0011209-22-2020Oregon'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-09-18-0303309-21-2020Connecticut Did Not Meet Federal and State Requirements for Claiming Medicaid School-Based Child Health Services for Hartford Public Schools A-01-19-0000309-18-2020North 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 09-17-2020Illinois Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-05-18-00037 09-16-2020Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations A-07-17-01176Medicare-Allowed Charges for Noninvasive Ventilators Are Substantially Higher Than Payment Rates of Select Non-Medicare Payers A-05-20-00008Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals A-07-20-00590 09-14-2020Maine Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-18-0607909-11-2020Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services A-05-18-00035Group Health Incorporated Overstated Its Allowable Medicare Supplemental Executive Retirement Plan Costs for Calendar Years 2009 Through 2016 A-07-19-00582Group 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-07-19-00579Group 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-07-19-00580Group Health Incorporated Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2009 Through 2016 A-07-19-0058109-08-2020Indiana Did Not Ensure That Medicaid Payments Were Made Properly for Some Claims Identified as Having Third-Party Coverage A-05-18-00046 09-04-2020Audit of Medicare Part D Pharmacy Fees: Horizon Blue Cross Blue Shield, Inc. A-03-18-0000709-03-2020Baylor Scott & White—College Station: Audit of Outpatient Outlier Payments A-06-18-0400309-01-2020Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group A-07-19-02822Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center A-07-18-0511208-27-2020Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program A-06-17-0900208-25-2020Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00017Illinois Claimed Unallowable Telemedicine Payments A-05-18-00028Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements A-05-18-00043Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process A-05-18-0002408-21-2020 CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete A-05-16-0005108-19-2020New 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-02-18-0100608-18-2020Indiana Properly Reported Adjustments Related to the Drug Rebate Program A-05-19-0002808-14-2020Nebraska Claimed Unallowable School-Based Administrative Costs Because of Improper Coding of Random Moment Timestudy Responses A-07-19-0323408-11-2020Medicare Home Health Agency Provider Compliance Audit: Mission Home Health of San Diego, Inc. A-09-18-03008 08-10-2020Visionquest Industries, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03010Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc. A-02-17-0102208-06-2020Desoto Home Health Care, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-0302108-05-2020 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 08-04-2020Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2019 A-18-20-11300 07-29-2020North 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-04-17-0406307-27-2020The New York State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-04-19-0622307-24-2020Factsheet: Ohio's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-05-19-0003607-22-2020CMS 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-09-18-0303107-21-2020On-Site Psychological Services, P.C.: Audit of Medicare Payments for Psychotherapy Services A-02-19-01012Alaska Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-09-19-0200107-15-2020CMS Did Not Administer and Manage Strategic Communications Services Contracts in Accordance With Federal Requirements A-12-19-2000307-13-2020Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims A-03-17-0001007-10-2020Medicaid Data Can Be Used To Identify Instances of Potential Child Abuse or Neglect A-01-19-0000107-09-2020Texas 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 07-06-2020Freedom Orthotics, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03012 06-03-2020Texas Telemedicine Services Were Provided in Accordance with State Requirements A-06-18-0500106-01-2020New Jersey Did Not Ensure That Its Managed Care Organizations Adequately Assessed and Covered Medicaid Beneficiaries' Needs for Long-Term Services and Supports A-02-17-0101805-22-2020Medicare Hospital Provider Compliance Audit: The Ohio State University Hospital A-05-18-0004205-01-2020Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays A-01-17-0050804-29-2020North Carolina Received $30 Million in Excess Federal Funds Related to Improperly Claimed Health Home Expenditures A-04-18-0012004-20-2020Grand Desert Psychiatric Services: Audit of Medicare Payments for Psychotherapy Services A-09-19-0301804-17-2020Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-20-00589Palmetto 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-07-20-00587Palmetto Government Benefits Administrator, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-0058604-16-2020Recommendation Followup: Michigan Did Not Report and Refund the Full Federal Share of Medicaid Overpayments A-05-18-0002204-09-2020Medicare Home Health Agency Provider Compliance Audit: Residential Home Health A-05-16-00063An 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 04-07-2020New 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-07-18-0410904-01-202096 Percent of South Carolina's Medicaid Fee-for-Service Telemedicine Payments Were Insufficiently Documented or Otherwise Unallowable A-04-18-0012203-27-2020Medicare Hospital Provider Compliance Audit: Forbes Hospital A-03-18-00005Iowa Did Not Comply With Federal and State Requirements for Major Incidents Involving Medicaid Members With Developmental Disabilities A-07-18-06081 03-26-2020New 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 03-25-2020Medicare Dialysis Services Provider Compliance Review: Bio-Medical Applications of Arecibo, Inc. A-02-17-01016 03-24-2020Most 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-07-18-0281203-23-2020 Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers A-04-18-07080 03-17-2020CMS 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 03-13-2020Missouri Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-18-0323003-06-2020Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-18-0806503-03-2020Factsheet: Kentucky's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-0202203-02-2020Medicare Hospital Provider Compliance Audit: Saint Francis Health Center A-07-17-05102 02-28-2020The 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 02-25-2020CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments A-06-16-01002 02-20-2020New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers A-02-18-0102002-19-2020New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-02-18-0101102-14-2020Michigan Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-05-17-0004802-11-2020The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes A-05-17-0002002-07-2020The 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 02-06-2020New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option A-02-17-0101502-06-2020Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes A-06-19-0800102-04-2020New 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 01-29-2020The Indiana State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-05-19-00007 01-24-2020More Than One-Third of New Jersey's Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable A-02-17-0102001-21-2020CMS's Implementation of a 2014 Policy Change Resulted in Improvements in the Reporting of Coverage Gap Discounts Under Medicare Part D A-07-16-0606701-17-2020Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-03-17-0020201-13-2020CMS'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-02-18-01003201912-16-2019Novitas Solutions, Inc. Needs Enhanced Guidance and Provider Education Related to Phlebotomy Travel Allowances A-06-17-04002 12-12-2019CMS Made an Estimated $93.6 Million in Incorrect Medicare Electronic Health Record Incentive Payments to Acute-Care Hospitals, or Less Than 1 Percent of $10.8 Billion in Total Incentive Payments A-09-18-0302012-10-2019Medicare Hospital Provider Compliance Audit: Texas Health Presbyterian Hospital Dallas A-04-18-0806812-05-2019Medicare Home Health Agency Provider Compliance Audit: Palos Community Hospital Home Health Agency A-05-17-0002211-27-2019Medicare Hospital Provider Compliance Audit: St. Vincent Hospital A-05-18-00040Factsheet: Alabama's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-0012511-26-2019Medicare Hospital Provider Compliance Audit: Northwest Medical Center A-04-18-08064 Medicare Hospital Provider Compliance Audit: Carolinas Hospital A-04-18-0806311-22-2019Hospitals Received Millions in Excessive Outlier Payments Because CMS Limits the Reconciliation Process A-05-16-00060 11-21-2019Noridian Healthcare Solutions, LLC, Did Not Claim Allowable Medicare Nonqualified Costs A-07-19-00574 Noridian Healthcare Solutions, LLC, Did Not Claim Allowable Medicare Nonqualified Costs Through Its Incurred Cost Proposals A-07-19-00573 11-20-2019Cahaba Safeguard Administrators, LLC, Properly Updated the Medicare Segment Pension Assets as of January 1, 2017 A-07-19-00571 Cahaba Government Benefits Administrators, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-19-00570 11-18-2019Registered Nurses Did Not Always Visit Medicare Beneficiaries' Homes At Least Once Every 14 Days To Assess The Quality of Care and Services Provided by Hospice Aides A-09-18-0302211-13-2019California Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-09-18-02009 11-12-2019Highlands of Little Rock West Markham Holdings, LLC: Audit of Documentation of Therapy Resource Utilization Groups A-06-18-08003 11-08-2019New Jersey Improperly Claimed Tens of Millions for Medicaid School-Based Administrative Costs Based on Random Moment Sampling That Did Not Meet Federal Requirements A-02-17-01006 11-07-2019The University of Minnesota Complied With Federal Requirements To Perform Risk Assessments and Monitor Subrecipients A-05-18-00015 Medicare Made Hundreds of Thousands of Dollars in Overpayments for Chronic Care Management Services A-07-17-05101 11-06-2019Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-19-00569Noridian Healthcare Solutions, LLC, Did Not Claim Some Allowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00568Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Postretirement Benefit Assets A-07-19-00567Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-18-00550Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Pension Costs A-07-18-00548Noridian Healthcare Solutions, LLC, Understated Its Medicare Segment Pension Assets A-07-18-0054711-01-2019Medicare Improperly Paid Acute-Care Hospitals $54.4 Million for Inpatient Claims Subject to the Post-Acute-Care Transfer Policy A-09-19-0300710-31-2019Audit of Medicare Part D Pharmacy Fees: Geisinger Health Systems, Inc. A-03-18-00006Medicare Improperly Paid Suppliers an Estimated $92.5 Million for Inhalation Drugs A-09-18-03018 10-30-2019Medicare Allowable Amounts for Certain Orthotic Devices Are Not Comparable With Payments Made by Select Non-Medicare Payers A-05-17-00033Medicare Home Health Agency Provider Compliance Review: Angels Care Home Health A-07-16-0509310-29-2019Tennessee Made Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid Identification Numbers A-04-18-0707910-23-2019The Centers for Medicare & Medicaid Services Could Improve Its Processes for Evaluating and Reporting Payment Recovery Savings Associated With the Fraud Prevention System A-01-15-0051010-21-2019Texas Did Not Ensure That Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-06-16-01001)Rhode Island Hospital Submitted Some Inaccurate Wage Data A-01-17-00509Sunshine ACO, LLC, Generally Reported Complete and Accurate Data on Quality Measures Through the CMS Web Portal, but There Were a Few Reporting Deficiencies That Did Not Affect the Overall Quality Performance Score (A-09-18-03019) 10-01-2019The Minnesota State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths (A-05-17-00049)09-30-2019Wisconsin Physicians Service Needs Enhanced Guidance and Provider Education Related to Phlebotomy Travel Allowances (A-06-17-04005)California Needs To Improve Oversight of Community-Based Adult Services Providers' Compliance With Health and Safety and Administrative Requirements (A-09-18-02002)09-26-2019National Government Services, Inc., Did Not Claim Some Medicare Postretirement Benefit Plan Costs Through Its Incurred Cost Proposals (A-07-19-00566) National Government Services, Inc., Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals (A-07-19-00572)National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals (A-07-19-00564)National Government Services, Inc., Claimed Some Unallowable Medicare Supplemental Executive Retirement Plan Costs Through Its Incurred Cost Proposals (A-07-19-00565)09-24-2019National Government Services, Inc., Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Final Administrative Cost Proposals (A-07-19-00563)National Government Services, Inc., Claimed Some Unallowable Supplemental Executive Retirement Plan Costs Through Its Final Administrative Cost Proposals (A-07-18-00551) 09-19-2019CMS Paid Over $277 Million in Unallowable CHIPRA Bonus Payments Based on Incorrect Enrollment Data (A-04-17-08061)09-12-2019Ohio Made Medicaid Capitation Payments That Were Duplicative or Were Improper Based on Beneficiary Eligibility Status or Demographics (A-05-16-00061) 09-11-2019 Medicare Incorrectly Paid Providers for Emergency Ambulance Transports From Hospitals to Skilled Nursing Facilities (A-09-18-03030) 09-05-2019The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home Health Agencies (A-05-17-00035)08-30-2019Twin Palms Received Unallowable Medicare Payments for Chiropractic Services (A-04-16-07065) Colorado Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries (A-07-16-04228) Florida Medicaid Paid Hundreds of Millions in Unallowable Payments to Jackson Memorial Hospital Under Its Low Income Pool Program (A-04-17-04058)New Jersey Did Not Bill Manufacturers for Tens of Millions of Dollars in Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-02-16-01011) 08-29-2019West Florida ACO, LLC, Generally Reported Complete and Accurate Data on Quality Measures Through the CMS Web Portal, but There Were a Few Reporting Deficiencies That Did Not Affect the Overall Quality Performance Score (A-09-18-03003)08-28-2019Oceanside Medical Group Received Unallowable Medicare Payments for Psychotherapy Services (A-09-18-03004)08-22-2019Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit (A-06-17-08004)08-21-2019Texas Did Not Bill Manufacturers for Some Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-06-17-04001)08-20-2019Illinois Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths (A-05-18-00026)Mederi Caretenders Home Health Billed for Home Health Services That Did Not Comply With Medicare Billing Requirements (A-07-16-05092) Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2018 (A-18-19-11300)New York Incorrectly Claimed Enhanced Federal Medicaid Reimbursement for Some Beneficiaries (A-02-15-01023)New York Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness (A-02-17-01027) 08-16-2019Connecticut Claimed Unallowable Federal Reimbursement for Medicaid Physician-Administered Drugs That Were Not Invoiced to Manufacturers for Rebates (A-07-18-06078) 08-09-2019Georgia Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths (A-04-15-06183)08-07-2019Pennsylvania Did Not Ensure That Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-03-16-00205)07-25-2019Group Health Incorporated Understated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets as of January 1, 2015 (A-07-19-00561)Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Pension Assets as of January 1, 2015 (A-07-19-00562)Group Health Incorporated Understated Its Cash Balance Pension Plan Medicare Segment Pension Assets as of January 1, 2011 (A-07-19-00557) 07-24-2019Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic (A-09-18-01005)07-23-2019A Resource Guide for Using Diagnosis Codes in Health Insurance Claims To Help Identify Unreported Abuse or Neglect (A-01-19-00502)07-17-2019New York Did Not Correctly Determine Medicaid Eligibility for Some Non-Newly Eligible Beneficiaries (A-02-16-01005)07-09-2019Kentucky Did Not Comply With Federal Waiver and State Requirements at 14 of 20 Adult Day Health Care Facilities Reviewed (A-04-18-00123) 07-02-2019New York's Claims for Medicaid Nursing Home Transition and Diversion Waiver Program Services Generally Complied With Federal and State Requirements but Had Reimbursement Errors That Resulted in a Minimal Amount of Overpayments (A-02-17-01005) 07-01-2019New York Claimed Federal Reimbursement for Some Payments to Health Home Providers That Did Not Meet Medicaid Requirements (A-02-17-01004)Medicare Part D Rebates for Prescriptions Filled at 340B Contract Pharmacies (A-03-16-00002)06-27-2019Recommendation Followup: Delaware Is Reporting Medicaid Overpayments In Compliance With Federal Requirements (A-03-17-00203)06-18-2019Illinois Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-05-18-00030)06-13-2019Medicare Could Have Saved Millions of Dollars in Payments for Three-Dimensional Conformal Radiation Therapy Planning Services (A-09-18-03026)06-12-2019CMS Could Use Medicare Data To Identify Instances of Potential Abuse or Neglect (A-01-17-00513)Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated (A-01-16-00509)Medicare Payments to Providers for Polysomnography Services Did Not Always Meet Medicare Billing Requirements (A-04-17-07069)06-11-2019Alaska Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities (A-09-17-02006)06-04-2019Princeton Place Did Not Always Comply With Care Plans for Residents Who Were Diagnosed With Urinary Tract Infections (A-06-17-02002)The Therapy Resource Utilization Groups at Epworth Villa Retirement Community's Skilled Nursing Facility Were Properly Supported (A-06-18-08002)05-30-2019New York May Not Have Complied With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-02-16-01022) 05-28-2019Great Lakes Home Health Services, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-05-16-00057) 05-23-2019St. Joseph's Hospital and Medical Center Submitted Some Inaccurate Wage Data (A-01-17-00510) 05-20-2019Metropolitan Jewish Home Care, Inc., Billed for Home Health Services That Did Not Comply with Medicare Requirements (A-02-16-01001) 05-16-2019Four States Did Not Comply With Federal Waiver and State Requirements in Overseeing Adult Day Care Centers and Foster Care Homes (A-05-19-00005) 05-13-2019EHS Home Health Care Service, Inc., Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-05-16-00055) 05-09-2019New Jersey Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-02-16-01012) 05-08-2019Massachusetts Did Not Ensure Its Managed-Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-01-17-00003)Excella HomeCare Billed for Home Health Services That Did Not Comply With Medicare Coverage and Payment Requirements (A-01-16-00500)05-07-2019California Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths (A-04-18-06220)04-30-2019Some Diagnosis Codes That Essence Healthcare, Inc., Submitted to CMS Did Not Comply With Federal Requirements (A-07-17-01170)04-29-2019Medicaid Could Save Hundreds of Millions by Excluding Authorized Generic Drug Transactions to Secondary Manufacturers from Brand Name Drugs� Average Manufacturer Price Calculations (A-06-18-04002)04-26-2019Trends in Deficiencies at Nursing Homes Show That Improvements Are Needed To Ensure the Health and Safety of Residents (A-09-18-02010)04-05-2019Indiana Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-05-17-00038)03-27-2019Factsheet: Texas' Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-06-18-04000)03-25-2019New Jersey Did Not Provide Adequate Oversight of Its Medicaid Delivery System Reform Incentive Payment Program (A-02-17-01007)03-05-2019Factsheet: West Virginia's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-03-18-03302) Missouri Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services (A-07-17-03219)02-28-2019Michigan Disbursed Only Part of Its Civil Money Penalty Collections, Limiting Resources To Protect or Improve Care for Nursing Facility Residents (A-05-17-00019)02-25-2019 Factsheet: New Hampshire's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-01-18-01501)02-14-2019CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met (A-05-16-00043) Factsheet: Nevada's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-09-18-01004)02-12-2019New Mexico Did Not Always Appropriately Refund the Federal Share of Recoveries from Managed Care Organizations (A-06-18-09001)TrustSolutions, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals (A-07-18-00540) 02-08-2019Factsheet: Utah's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-07-18-05115)02-06-2019Factsheet: Tennessee's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-04-18-00124) 02-07-2019CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs To Be Improved To Help Ensure the Health and Safety of Nursing Home Residents (A-09-18-02000) 02-06-2019Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements (A-01-17-00506) 02-04-2019Medicare Compliance Review of Community Hospital (A-05-17-00026)01-31-2019Factsheet: Nebraska's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-07-18-06080)01-17-2019Kelley Medical Equipment and Supply, LLC, Received Unallowable Medicare Payments for Orthotic Braces (A-09-17-03030) 01-15-2019Although the Centers for Medicare & Medicaid Services Has Made Progress, It Did Not Always Resolve Audit Recommendations in Accordance With Federal Requirements (A-07-18-03228) 01-10-2019Virginia Received Millions in Unallowable Bonus Payments (A-04-17-08060)01-04-2019 Rhode Island Did Not Ensure Its Managed Care Organizations Complied With Requirements Prohibiting Medicaid Payments for Services Related to Provider-Preventable Conditions (A-01-17-00004)201812-31-2018A Queens Chiropractor Received Improper Medicare Payments for Chiropractic Services (A-02-15-01003)Pacific Medical, Inc., Received Some Unallowable Medicare Payments for Orthotic Braces (A-09-17-03027)12-28-2018Dialysis Services Provided by Atlantis Health Care Group of Puerto Rico, Inc., Did Not Comply With Medicare Requirements Intended To Ensure the Quality of Care Provided to Medicare Beneficiaries (A-02-16-01009)12-20-2018First Coast Service Options, Inc., Paid Providers for Hyperbaric Oxygen Therapy Services That Did Not Comply With Medicare Requirements (A-04-16-06196) 12-19-2018Midwood Ambulance & Oxygen Service, Inc., Billed for Nonemergency Ambulance Transport Services That Did Not Comply With Medicare Requirements (A-02-16-01021)12-17-2018Louisiana Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-06-16-02003) 12-13-2018Wisconsin Did Not Report and Refund the Full Federal Share of Medicaid-Related Settlements and a Judgment (A-05-17-00041) 12-12-2018Texas Claimed Community First Choice Fee-for-Service Expenditures Appropriately (A-06-17-08002)12-11-2018Factsheet: Washington State's Oversight of Opioid Prescribing and Monitoring of Opioid Use (A-09-18-02001)California Made Medicaid Payments on Behalf of Non-Newly Eligible Beneficiaries Who Did Not Meet Federal and State Requirements (A-09-17-02002)12-07-2018The Centers for Medicare & Medicaid Services Had Not Recovered More Than a Billion Dollars in Medicaid Overpayments Identified by OIG Audits (A-05-17-00013)12-06-2018Payments Made by National Government Services, Inc., to Hospitals for Certain Advanced Radiation Therapy Services Did Not Fully Comply With Medicare Requirements (A-02-16-01007)Vulnerabilities Exist in State Agencies' Use of Random Moment Sampling To Allocate Costs for Medicaid School-Based Administrative and Health Services Expenditures (A-07-18-04107)11-30-2018Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2017 (A-18-18-11300)11-29-2018Medicare Improperly Paid Suppliers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Beneficiaries During Inpatient Stays (A-09-17-03035) 11-27-2018CMS's Enhanced Controls Did Not Always Prevent Terminated Drug Utilization in Medicare Part D (A-07-16-06068)11-23-2018New York May Have Improperly Claimed Medicaid Reimbursement for Certain Dental Services (A-02-16-01020)Summary of Security Vulnerabilities Identified at Two Arizona Managed Care Organizations and Inconsistent Treatment of Medicaid Data Security at the State Agency and Managed Care Organizations (A-18-17-09302)11-21-2018Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments (A-01-17-00500)11-07-2018National Government Services, Inc., Understated Its Plan A Medicare Segment Pension Assets (A-07-18-00541)National Government Services, Inc., Claimed Some Unallowable Medicare Pension Costs (A-07-18-00543)National Government Services, Inc., Did Not Claim Some Allowable Medicare Postretirement Benefit Costs (A-07-18-00552)11-08-2018Payments Made by Novitas Solutions, Inc., to Hospitals for Certain Advanced Radiation Therapy Services Did Not Fully Comply With Medicare Requirements (A-02-16-01006) Although Hospital Tax Programs in Seven States Complied With Hold-Harmless Requirements, the Tax Burden on Hospitals Was Significantly Mitigated (A-03-16-00202)11-01-2018CMS Did Not Always Ensure Hospitals Complied With Medicare Reimbursement Requirements for Graduate Medical Education (A-02-17-01017) 10-25-2018New York Claimed Federal Reimbursement for Some Assertive Community Treatment Services That Did Not Meet Medicaid Requirements (A-02-17-01008)10-24-2018Professional Clinical Laboratory, Inc., Generally Did Not Comply With Medicare Requirements For Billing Phlebotomy Travel Allowances (A-06-16-02002)10-18-2018Medicare Compliance Review of Mobile Infirmary Medical Center (A-04-17-08057) 10-16-2018United Government Services, LLC, Properly Updated the Medicare Segment Pension Assets as of January 1, 2015 (A-07-18-00538)TrustSolutions, LLC, Properly Updated the Medicare Segment Pension Assets as of December 31, 2012 (A-07-18-00539)National Government Services, Inc., Properly Updated the Plan B Medicare Segment Pension Assets as of January 1, 2015 (A-07-18-00542) 10-15-2018Wisconsin Did not Comply With Federal Waiver and State Requirements at all 20 Adult Day Care Centers Reviewed (A-05-17-00030)10-04-2018Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths 09-27-2018 Wisconsin Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries� Deaths (A-05-17-00006)Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements (A-01-15-00500)09-19-2018Etheredge Chiropractic Received Unallowable Medicare Payments for Chiropractic Services (A-04-16-07064) 09-11-2018First Coast Service Options, Inc., Overstated Medicare�s Share of the Medicare Segment Excess Pension Liabilities (A-07-18-00535)09-06-2018 National Institute of Transplantation, an Independent Histocompatibility Laboratory, Did Not Fully Comply With Medicare�s Cost-Reporting Requirements (A-09-16-02010)09-04-2018CMS Enrollment System Needs To Enhance Resiliency (A-18-17-06501)08-20-2018Mississippi Did Not Comply With Federal Waiver and State Requirements at All 20 Adult Day Care Facilities Reviewed (A-04-17-00116)08-17-2018Liberty Medical, LLC, Received Unallowable Medicare Payments for Inhalation Drugs (A-09-17-03019)06-25-2018Virginia Did Not Claim Some Medicaid Administrative Costs for Its Medallion 3.0 Waiver Program In Accordance With Federal Requirements (A-03-17-00200)08-15-2018Medicare Improperly Paid Hospitals Millions of Dollars for Intensity-Modulated Radiation Therapy Planning Services (A-09-16-02033) Medicare Made Improper and Potentially Improper Payments for Emergency Ambulance Transports to Destinations Other Than Hospitals or Skilled Nursing Facilities (A-09-17-03017)08-08-2018California Claimed Millions of Dollars in Unallowable Federal Medicaid Reimbursement for Specialty Mental Health Services (A-09-15-02040)California Created a Medicaid Program Vulnerability by Reporting Placeholders That Did Not Represent Actual Expenditures Supported by Documentation (A-09-15-02027)08-09-2018Maryland Did Not Adequately Secure Its Medicaid Data and Information Systems (A-18-16-30520)Alaska Received Millions in Unallowable Bonus Payments (A-04-17-08059) 08-08-2018CMS Did Not Always Accurately Authorize Financial Assistance Payments to Qualified Health Plan Issuers in Accordance With Federal Requirements During the 2014 Benefit Year (A-02-15-02013)07-31-2018Medicare Compliance Review of WakeMed Raleigh Campus (A-04-17-04057)07-24-2018Illinois Did Not Comply With Federal Waiver and State Requirements at 18 of 20 Adult Day Service Centers Reviewed (A-05-17-00028) Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part A Administrative Costs for Fiscal Year 2013 (A-05-16-00052)Wisconsin Physicians Service Insurance Corporation Claimed Unallowable Medicare Part B Administrative Costs for Fiscal Year 2013 (A-05-16-00053) 07-16-2018First Coast Service Options, Inc., Did Not Claim Some Medicare Supplemental Executive Retirement Plan Costs Through Its Incurred Cost Proposals (A-07-18-00536) First Coast Service Options, Inc., Generally Claimed Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-18-00534) 07-11-2018Medicare Improperly Paid Providers for Nonemergency Ambulance Transports to Destinations Not Covered by Medicare (A-09-17-03018) 07-09-2018The Colorado Health Insurance Marketplace�s Financial Management System Did Not Always Comply With Federal Requirements (A-07-17-02808) 07-05-2018Medicare Improperly Paid Providers for Items and Services Ordered by Chiropractors (A-09-17-03002)06-25-2018Virginia Did Not Claim Some Medicaid Administrative Costs for Its Medallion 3.0 Waiver Program In Accordance With Federal Requirements (A-03-17-00200) 06-14-2018Michigan Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Brokerage Program (A-05-16-00021)06-07-2018Most Medicare Claims for Replacement Positive Airway Pressure Device Supplies Did Not Comply With Medicare Requirements (A-04-17-04056)06-05-2018Companion Data Services, LLC, Did Not Claim Some Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00528) 06-04-2018New York Claimed Federal Reimbursement for Consumer-Directed Personal Assistance Services That Did Not Meet Medicaid Requirements (A-02-16-01026)06-01-2018University of Wisconsin Hospitals and Clinics Authority Incorrectly Billed Medicare Inpatient Claims With Severe Malnutrition (A-03-17-00005)05-30-2018Nebraska Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-07-17-03224)Texas Made Increased Payments for Services Rendered by Eligible Primary Care Providers Under Federal Requirements (A-06-17-09003)Minnesota Did Not Comply With Federal Waiver and State Requirements for All 20 Adult Day Care Centers Reviewed (A-05-17-00009)05-29-2018Nevada Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-09-15-02039)05-22-2018CMS Did Not Always Provide Accurate Medicaid Unit Rebate Offset Amounts to State Medicaid Agencies (A-07-17-06074)05-14-2018Iowa Complied With Most Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-07-17-03221) Missouri Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions (A-07-16-03216)05-10-2018Wisconsin Physicians Service Insurance Corporation Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00530) Wisconsin Physicians Service Insurance Corporation Understated Medicare�s Share of the Medicare Segment Excess Pension Assets (A-07-17-00529) 04-30-2018 Cahaba Safeguard Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00526)Cahaba Government Benefits Administrators, LLC, Understated Medicare Administrative Contract Allowable Pension Costs (A-07-17-00525)Cahaba Government Benefits Administrators, LLC, Generally Claimed Allowable Medicare Pension Costs (A-07-17-00524)04-27-18Florida Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-04-17-08052)04-25-2018Cahaba Government Benefits Administrators, LLC, Overstated Its Medicare Segment Pension Assets (A-07-17-00522) 04-24-2018Most of New York�s Claims for Federal Reimbursement for Monthly Personal Emergency Response Service Charges Did Not Comply With Medicaid Requirements (A-02-15-01019) Cahaba Safeguard Administrators, LLC, Understated Its Medicare Segment Pension Assets (A-07-17-00523)First Coast Service Options, Inc.�s, Postretirement Benefit Costs Were Reasonable and Allowable (A-07-17-00501)04-18-2018Colorado Did Not Always Comply With Federal Requirements When Expending Federal Establishment Grant Funds Allocated for Its Shared Eligibility System Costs (A-07-16-02804)04-12-2018CMS's Policies and Procedures Were Generally Effective in Ensuring That Prescription Drug Coverage Capitation Payments Were Not Made After the Beneficiaries' Dates of Death (A-07-16-05088)04-05-2018CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements (A-05-16-00058) 04-04-2018Colorado Claimed Some Unallowable Medicaid Payments for Targeted Case Management Services (A-07-16-03215)Texas Did Not Make Increased Primary Care Provider Payments and Claim Reimbursement in Accordance With Federal Requirements (A-06-15-00045)03-21-2018New Jersey Claimed Federal Medicaid Reimbursement for Children's Partial Hospitalization Services That Did Not Meet Federal and State Requirements (A-02-16-01008) 03-20-2018Idaho Received Millions in Unallowable Bonus Payments (A-04-17-08056)03-16-2018New York Did Not Comply With Federal Grant Requirements for Claiming Marketplace Contract Costs to Medicaid and the Children's Health Insurance Program (A-02-15-01014) 03-14-2018Many Medicare Claims for Outpatient Physical Therapy Services Did Not Comply With Medicare Requirements (A-05-14-00041)03-08-2018Hospitals Did Not Comply With Medicare Requirements for Reporting Certain Cardiac Device Credits (A-05-16-00059) 03-06-2018>Oklahoma Did Not Have Procedures to Identify Provider-Preventable Conditions on Some Inpatient Hospital Claims (A-06-16-08004)02-20-2018California Made Medicaid Payments on Behalf of Newly Eligible Beneficiaries Who Did Not Meet Federal and State Requirements (A-09-16-02023) 02-16-2018Arizona Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations (A-09-16-02031)02-14-2018Medicare Improperly Paid Providers for Specimen Validity Tests Billed in Combination With Urine Drug Tests (A-09-16-02034)Wisconsin Physicians Service Paid Providers for Hyperbaric Oxygen Therapy Services That Did Not Comply With Medicare Requirements (A-01-15-00515)02-13-2018Medicare Compliance Review of Memorial University Medical Center (A-04-17-08055) 02-12-2018 Medicare Needs Better Controls To Prevent Fraud, Waste, and Abuse Related to Chiropractic Services (A-09-16-02042)Arkansas Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs (A-06-16-00018)02-09-2018Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2016 (A-18-17-11300)01-31-2018Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00506)01-30-2018 CGS Administrators, LLC, Did Not Claim Some Allowable Pension Costs Through Its Incurred Cost Proposals (A-07-17-00513) 01-23-2018Medicare Compliance Review of the University of Michigan Health System (A-05-16-00064)01-11-2018Medicare Compliance Review of Carolinas Medical Center (A-04-16-04049) 01-05-2018Wisconsin Physicians Service Insurance Corporation Did Not Claim Some Allowable Medicare Pension Costs (A-07-17-00519)Wisconsin Physicians Service Insurance Corporation Understated Its Allocable Pension Costs (A-07-17-00520)New York Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries (A-02-15-01015)01-04-2018North Carolina Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid (A-04-17-02500) Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Employees' Pension Plan (A-07-17-00516) Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Managerial Retirement Program for Selected Locations (A-07-17-00517)Wisconsin Physicians Service Insurance Corporation Understated Its Medicare Segment Pension Assets for Its Managerial Pension Plan (A-07-17-00518)What area does the Centers for Medicare and Medicaid Services CMS regulate?The CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
What agency is CMS part of?The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS).
Where is the CMS headquarters?Baltimore, MDCenters for Medicare & Medicaid Services / Headquartersnull
Is CMS a state or federal agency?The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the federally facilitated Marketplace. For more information, visit cms.gov.
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The centers for medicare and medicaid services agency is located in the
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