Reports

• CMS Could Strengthen Program Safeguards To Prevent and Detect Improper Medicare Payments for Short Inpatient Stays

  

• Washington Medicaid Fraud Control Unit: 2023 Inspection

  

• Spring 2024 Semiannual Report to Congress

  

• 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

  

• Plans and Enrollment Often Fell Short for Underrepresented Groups in a Sample of NIH-Funded Clinical Trials

  

• Medicaid Managed Care: States Do Not Consistently Define or Validate Paid Amount Data for Drug Claims;

  

• 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

  

• California Improperly Claimed $52.7 Million in Federal Medicaid Reimbursement for Capitation Payments Made on Behalf of Noncitizens With Unsatisfactory Immigration Status

  

• 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

  

• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2023 

  

• 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 

  

• New York Medical College Claimed Unallowable Grant Costs and Did Not Meet Certain Financial Conflict of Interest Requirements 

  

• California Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements

  

• State Agencies Could Be Obtaining Hundreds of Millions in Additional Medicaid Rebates Associated With Physician-Administered Drugs

  

• Potential Vulnerabilities in CMS Oversight of Medicare Add-on Payments for COVID-19 Tests Show That Oversight of Incentive Payments Could Be Improved

  

• New Mexico Should Refund Almost $120 Million to the Federal Government for Medicaid Nursing Facility Level-of-Care Managed Care Capitated Payments

  

• 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

  

• Medicaid Enrollees May Not Be Screened for Intimate Partner Violence Because of Challenges Reported by Primary Care Clinicians

  

• The Office of Intergovernmental and External Affairs’ Purchase Card Program Did Not Comply With Federal and HHS Requirements

  

• Florida Ensured That Nursing Homes Complied with Federal Background Check Requirements