Reports

• Many Medicaid Enrollees with Opioid Use Disorder Were Treated with Medication; However, Disparities Present Concerns

  

• Biosimilars Have Lowered Costs for Medicare Part B and Enrollees, but Opportunities for Substantial Spending Reductions Still Exist

  

• New Jersey Could Better Ensure That Nursing Homes Comply With Federal Requirements for Life Safety, Emergency Preparedness, and Infection Control

  

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Aetna, Inc. (Contract H5521) Submitted to CMS

  

• Texas Made Capitation Payments for Enrollees Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Another State

  

• CDC Provided Oversight and Assistance; However, ELC Recipients Still Faced Challenges in Implementing COVID-19 Screening Testing Programs

  

• Four States Reviewed Received Increased Medicaid COVID-19 Funding Even Though They Terminated Some Enrollees Coverage for Unallowable or Potentially Unallowable Reasons

  

• Medicare Advantage Compliance Audit of Diagnosis Codes That Health Net of California, Inc. (Contract H0562) Submitted to CMS

  

• Alabama Did Not Always Invoice Rebates to Manufacturers for Pharmacy and Physician-Administered Drugs

  

• Supplemental Data on Tobacco Retailer Inspections

  

• Review of Personnel Shortages in Federal Health Care Programs During the COVID-19 Pandemic

  

• New York Did Not Ensure That a Managed Care Organization Complied With Requirements for Denying Prior Authorization Requests

  

• Key Strategies That States Used for Managing Medicaid and Marketplace Enrollment During the COVID-19 PHE

  

• Kentucky Did Not Always Invoice Manufacturers for Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations

  

• Novitas Solutions, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals

  

• Puerto Rico Claimed Over $7 Million in Federal Reimbursement for Medicaid Capitation Payments Made on Behalf of Enrollees Who Were or May Have Been Deceased

  

• Puerto Rico Claimed More Than $500 Thousand in Unallowable Medicaid Managed Care Payments for Enrollees Assigned More Than One Identification Number

  

• Medicare Improperly Paid Acute-Care Hospitals for Inpatient Claims Subject to the Post-Acute-Care Transfer Policy Over a 4-Year Period, but CMS System Edits Were Effective in Reducing Improper Payments by the End of the Period

  

• Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients

  

• Nursing Homes Reported Wide-Ranging Challenges Preparing for Public Health Emergencies and Natural Disasters