oig.hhs.gov

New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees

New York pays managed care organizations to make services available to eligible Medicaid enrollees in return for a monthly fixed payment (capitation payment) for each enrollee. Previous audits found ...
oig.hhs.gov

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), Submitted to CMS

Under the Medicare Advantage (MA) program, CMS makes monthly payments to MA organizations based in part on the health status of the enrollees being covered. To determine the health status of enrollees ...
oig.hhs.gov

South Carolina Did Not Report Approximately $108.6 Million of the Federal Share of Medicaid and CHIP Collections Subject to the Increased COVID-19 Federal Medical Assistance ...

Collections of Medicaid and Children’s Health Insurance Program (CHIP) expenditures (e.g., overpayments recovered, refunds, and similar receipts) reduce the net reported expenditures and therefore ...
oig.hhs.gov

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies each Unit, and oversees the Units’ compliance with the requirements of the grant and adherence to 12 ...