HHS-OIG

HHS Agencies' Drug Control Funds Review Completed

The HHS Office of Inspector General has completed its mandatory review of HHS agencies' annual accounting of National Drug Control Program funds for fiscal year 2025. The review, which assessed compliance with ONDCP circular requirements, found no material modifications needed for the CDC and FDA reports.

Medicare Advantage Risk-Adjustment Data - Documentation Review

The HHS OIG announced a series of projects to review documentation supporting diagnosis codes submitted by Medicare Advantage organizations to CMS. CMS estimates 9.5% of payments to MA organizations are improper due to unsupported diagnoses.

Kidney Transplant Patient Selection Criteria and Waitlist Outcomes Report

The HHS Office of Inspector General has completed a report on patient selection criteria for kidney transplants and waitlist outcomes. The report found that half of patients evaluated for a kidney transplant in 2023 were not added to the waitlist, with psychosocial criteria being a common reason for denial.

Hospital Billing Requirements Review for Overpayment Risk

The Centers for Medicare and Medicaid Services (CMS) announced a review series focused on hospital billing requirements to identify overpayment risks. A completed project for Sarasota Memorial Hospital identified at least $12.1 million in Medicare overpayments due to non-compliance with billing requirements.

Medicaid Applied Behavior Analysis Audits for Children with Autism

The HHS Office of Inspector General announced a series of audits of Medicaid Applied Behavior Analysis (ABA) services for children with autism. These audits aim to determine if state Medicaid agencies' payments complied with federal and state requirements, following identification of questionable billing patterns.

HHS OIG: Over $15 Million in Improper Medicare Payments for Non-Emergency Services

The HHS Office of Inspector General (OIG) reported that Medicare improperly paid physicians $922,524 and potentially $14.2 million to hospitals for services billed with emergency department procedure codes but rendered at non-emergency sites. The OIG recommends recovery of improper payments and improved claims processing controls.

HHS OIG: Colorado Medicaid Improper Payments for ABA Services

The HHS Office of Inspector General (OIG) found that Colorado made at least $77.8 million in improper fee-for-service Medicaid payments for Applied Behavior Analysis (ABA) services provided to children in 2022 and 2023. The OIG recommended Colorado refund $42.6 million to the Federal Government and improve guidance for ABA providers.

HHS OIG: Sarasota Memorial Hospital Medicare Overpayments Total $12.1 Million

The HHS Office of Inspector General (OIG) found that Sarasota Memorial Hospital received at least $12.1 million in Medicare overpayments between January 1, 2020, and December 31, 2021. The OIG recommended the hospital refund the overpaid amount and implement additional training.

HHS OIG Report: Alaska Missed Foster Care Opportunities for Native Children

The HHS Office of Inspector General issued a report finding that Alaska missed opportunities to protect American Indian and Alaska Native children missing from foster care. The report details failures in notification, follow-up actions, sex trafficking assessments, caseworker visits, and tribal communication, recommending improvements supported by ACF.

HHS OIG Audit of Utah Capitation Payments

The HHS Office of Inspector General (OIG) has issued an audit report, in partnership with the Utah Inspector General, concerning capitation payments made concurrently with another state. The report, dated February 20, 2026, details findings related to Medicaid payments.