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

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare of Wisconsin, Inc. (Contract H5253) 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

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract H5216) Submitted to CMS

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

States Have Missed Some Opportunities to Improve Medicaid Managed Care Organizations’ Provider Fraud Referrals

Fraud in Medicaid managed care depletes critical resources and may cause harm to enrollees. State Medicaid agencies (States) play a key role in protecting taxpayer dollars by overseeing Medicaid ...
oig.hhs.gov

Cookeville Regional Medical Center Agreed to Pay $20,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

After it self-disclosed conduct to OIG, Cookeville Regional Medical Center (CRMC), Cookeville, Tennessee, entered into a $20,000 settlement agreement with OIG. The settlement agreement resolves ...
oig.hhs.gov

Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees

The Medicare hospice benefit allows hospice providers to claim Medicare reimbursement for hospice services provided to enrollees with a life expectancy of 6 months or less who have elected hospice ...
oig.hhs.gov

Focused Review of State Child Care and Development Fund Program Integrity Efforts

The Child Care and Development Fund (CCDF) is a block grant that subsidizes child care for low-income working families. The program is administered by States, which are required to develop internal ...
oig.hhs.gov

Attorney General Raoul Charges Former Employee Of Chicagoland Assisted-Living Facility with Sexual Abuse

Chicago – Attorney General Kwame Raoul today announced charges against a former employee of a greater-Chicago assisted-living facility for sexual abuse committed against an individual with a ...
oig.hhs.gov

CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes

Under the Medicare Advantage (MA) program, CMS makes monthly payments to MA organizations according to a system of risk adjustment that depends on the demographic characteristics and health status of ...
oig.hhs.gov

Evaluation and Management Services on Same Day as Minor Surgery With No Modifier 25

Generally, Medicare reimbursement for an evaluation and management (E/M) service performed on the same day as a minor surgical procedure is included in the payment for the procedure. However, Medicare ...
oig.hhs.gov

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross and Blue Shield of Alabama (Contract H0104) 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

Former NFL Player and Laboratory Owner Convicted in $328M Genetic Testing Fraud Scheme

A federal jury in Dallas convicted a Texas laboratory owner and former NFL player yesterday for his role in a $328 million cardiovascular genetic testing fraud scheme. According to court documents and ...