HHS OIG Reports

CMS Has Limited Oversight of Selected Compounded Drugs in Medicare Part D

HHS OIG completed an audit (A-05-21-00008) of CMS oversight of compounded drugs under Medicare Part D, finding that CMS's oversight is limited because data obtained from sponsors does not provide a complete picture of compounded drug ingredients. The audit identified instances where enrollees received FDA-approved drugs potentially misidentified as compounded drugs, drugs subject to misuse (gabapentin) concurrent with opioid prescriptions, and controlled substances (ketamine) not listed on PDE records. OIG made three recommendations to CMS, all of which CMS concurred with.

Vibrent Health, NIH award, $16.5M unallowable costs

Vibrent Health, NIH award, $16.5M unallowable costs

Medicare Advantage Compliance Audit - Priority Health Diagnosis Codes

HHS OIG completed a compliance audit of Priority Health (Contract H2320) examining diagnosis codes submitted for Medicare Advantage risk adjustment. The audit found that 252 of 300 sampled enrollee-years had medical records that did not support the submitted diagnosis codes, resulting in $828,010 in net overpayments for the sample. Extrapolating to the full population, OIG estimated Priority Health received at least $4.4 million in net overpayments for 2018 and 2019. Priority disagreed with the findings and recommendations.

Medicare Home Health Agency Provider Compliance Audit: VNS Health

HHS OIG completed a compliance audit of VNS Health's Medicare home health claims for the period July 1, 2020, through June 30, 2022. Of 100 sampled claims, 16 contained errors resulting in $2,965,484 in overpayments. OIG recommends VNS Health refund the overpayments and conduct internal audits to identify similar billing errors.