The HHS OIG’s contractor self-disclosure program provides a means for contractors to self-disclose potential violations of the False Claims Act and various Federal criminal laws involving fraud, conflict of interest, bribery or gratuity. The Federal Acquisition Regulation (FAR) requires certain … Read More
Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas … Read More
Not all of the Medicaid direct medical service costs that the Kansas Department of Health and Environment, Division of Health Care Finance (State agency), claimed for school-based health services (SBHS) were reasonable, adequately supported, or otherwise allowable in accordance with … Read More
The Nebraska Department of Health and Human Services, Division of Finance and Support (State agency), did not always comply with Federal Medicaid requirements for billing drug manufacturers for rebates for physician-administered drugs. To collect these rebates, States submit to the … Read More
August 11, 2014 — In the latest development in the ongoing Texas Medicaid scandal, a federal report has laid the responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely … Read More
A federal auditor has laid responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely on the state agency that oversaw the program. The Texas Health and Human Services Commission … Read More
Last Wednesday, the Department of Health and Human Services, Office of Inspector General released the results of its long anticipated audit of Texas Medicaid orthodontic spending. The feds conducted the audit because Texas Medicaid payments for orthodontic services rose from … Read More
HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, … Read More
The owner and operator of a Houston area ambulance company was sentenced today to serve 97 months in prison for her role in a $2.4 million Medicare fraud scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal … Read More
Yesterday, HHS-OIG issued an audit entitled “Acute-Care Hospitals In Texas Did Not Always Reconcile Invoice Records With Credit Balances And Refund To The State Agency The Associated Medicaid Overpayments.” The federal auditors, in looking over eight acute care hospitals in Texas, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the Texas Health and Human Services Commission (State agency). However, the seven remaining hospitals in our sample did not always … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the State agency. However, the seven remaining hospitals in our sample did not always reconcile patient account credit balances and … Read More
This morning it was reported that the Inspector General of the Department of Health and Human Services issued a report that roughly 20% of all Medicare payments for evaluation and management claims in the United States are overpayments to physicians, … Read More
WHY WE DID THIS STUDY OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews … Read More
CSHM, which owns 54 Small Smiles dental clinics in the U.S., has agreed to sell the chain after the company was recently excluded from participating in the Medicaid and Medicare programs by the U.S. Department of Health and Human Services … Read More
Nothing about Texas Medicaid spending on dental or orthodontia. Medicaid Integrity Program Report for Fiscal Year 2013.
In an unheralded August 2012 audit report that is available online, the federal Health and Human Services Office of Inspector General found that the Texas Health and Human Services Commission had not returned $2.6 million in Medicaid funding back to … Read More
The Idaho Department of Health and Welfare (State agency) did not implement adequate information system general controls over its Medicaid claims processing system. We identified 19 reportable weaknesses, which we consolidated into 5 findings and grouped into access controls, configuration … Read More
The New Jersey Department of Human Services (State agency) generally claimed Federal reimbursement for Disproportionate Share Hospital (DSH) payments that did not exceed hospital-specific limits. DSH payments may not exceed hospitals’ uncompensated care costs for providing services to patients who … Read More
