HHS OIG Reports & Publications

Louisiana Healthcare Connections Prior Authorization Audit Findings

HHS OIG completed an audit of Louisiana Healthcare Connections (LHCC), a Louisiana Medicaid managed care organization, examining 76 sampled behavioral health service denials requiring prior authorization. LHCC complied with Federal and State requirements for 64 of 76 sampled denials (84%), but 12 denials failed to meet administrative or procedural requirements, primarily missing written notices of adverse determination. OIG estimates 3,209 prior authorization denials (15.8%) during the audit period did not comply with requirements.

Michigan Medicaid: Diabetes/Weight Loss Drugs Dispensed Per Requirements

The HHS Office of Inspector General (OIG) reported that selected diabetes and weight loss drugs dispensed to Michigan Medicaid managed care enrollees were in accordance with federal and state requirements. The audit found that Michigan ensured managed care organizations followed all applicable coverage and utilization requirements, including prior authorizations and quantity limits.

OIG Report: Part B Drug Payments Included Noncovered Self-Administered Versions, Increasing Costs

An HHS OIG report found that Medicare Part B payment amounts for the drug Omvoh included noncovered self-administered versions in 2024, increasing costs. Excluding these versions would have saved Part B and its enrollees an estimated $1,742 per vial in the fourth quarter of 2024. The report also noted that CMS's prior removal of noncovered self-administered versions for five other drugs saved $1.3 billion from 2023 through 2024.

HHS FISMA Compliance Report: Not Effective, 10 Recommendations Made

The HHS Office of Inspector General (OIG) has released a report rating HHS's compliance with the Federal Information Security Modernization Act (FISMA) for Fiscal Year 2025 as 'Not Effective' for the sixth consecutive year. The report details ten recommendations to improve HHS's information security program.

Medicaid Fraud Control Units Annual Report: FY 2025

The HHS OIG has released its annual report for Medicaid Fraud Control Units (MFCUs) for Fiscal Year 2025. The report details nearly $2 billion in combined criminal and civil recoveries, 1,185 convictions, and 900 exclusions from federal health care programs. It highlights trends in fraud and patient abuse investigations and prosecutions.

HHS OIG: Nursing Homes Misdiagnosed Residents to Mask Antipsychotic Drug Misuse

The HHS Office of Inspector General (OIG) issued a report finding that nursing homes inappropriately diagnosed residents with schizophrenia to mask the misuse of antipsychotic drugs and artificially inflate their star ratings. The OIG recommends that CMS expand its use of data to monitor these diagnoses and increase efforts to inform residents and families about antipsychotic drug use.

HHS OIG: Nursing Homes Misuse Antipsychotics on Dementia Residents

The HHS Office of Inspector General (OIG) issued a report finding that nursing homes inappropriately administer antipsychotic drugs to residents with dementia, often to manage behavior for staff benefit, despite FDA warnings of increased mortality risk. The report recommends CMS develop resources and increase transparency to reduce misuse and improve dementia care.

HHS OIG: Indiana Nursing Homes Generally Complied with Federal Background Check Requirements

The HHS Office of Inspector General (OIG) reported that Indiana nursing homes generally complied with federal requirements for employee background checks. Out of 825 employees reviewed, only 13 lacked completed background checks, and none had disqualifying offenses.

HHS OIG Audit of Gateway Health Plan Medicare Advantage Compliance

The HHS Office of Inspector General (OIG) audited Gateway Health Plan, Inc.'s submission of diagnosis codes to CMS for Medicare Advantage risk adjustment. The audit found that most sampled diagnosis codes were not supported by medical records, leading to an estimated $4.3 million in net overpayments for 2018 and 2019.

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: 14 Providers Improperly Claimed $70.6M in PRF Payments

The HHS Office of Inspector General (OIG) reported that 14 out of 30 selected Indian Health Service and rural providers did not comply with terms and conditions for expending $70.6 million in Provider Relief Fund (PRF) payments. The OIG recommended that HRSA require these providers to return unallowable expenditures.

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.

Missouri Failed to Collect $12.2M in Medicaid Drug Rebates

The HHS Office of Inspector General (OIG) found that Missouri failed to collect $12.2 million in federal rebates for Medicaid physician-administered and pharmacy drugs between January 1, 2019, and December 31, 2022. The OIG recommends Missouri refund the federal government $9.7 million for physician-administered drugs and $2.5 million for pharmacy drugs.

ACF Contract for Unaccompanied Alien Children Services Noncompliant

The HHS OIG found that the Administration for Children and Families (ACF) awarded a $529 million sole source contract for unaccompanied alien children services in a noncompliant manner. The contract was double the cost estimate and lacked required pre-award documentation.

HHS OIG: West Virginia Failed to Collect $6.1M in Medicaid Drug Rebates

The HHS Office of Inspector General found that West Virginia failed to collect an estimated $6.1 million in federal rebates for physician-administered drugs dispensed to Medicaid managed-care enrollees. The audit identified failures in internal controls that prevented the state from invoicing manufacturers for these rebates.

OIG Audit: Medicaid Agencies Made $207M in Unallowable Payments for Deceased Enrollees

The HHS OIG has released an audit report finding that Medicaid agencies made an estimated $207.5 million in unallowable capitation payments to managed care organizations on behalf of deceased enrollees between July 2021 and June 2022. The report recommends CMS provide agencies with data to recover payments and explore OBBB Act implementation.

Maine Medicaid Autism Services Improper Payments

The HHS OIG has issued a report finding that Maine made at least $45.6 million in improper fee-for-service Medicaid payments for autism services provided to children. The audit identified that all sampled claims were improper or potentially improper, leading to recommendations for refunds and improved provider guidance.

HHS OIG: ACF Can Improve Homeless Youth Services Compliance

The HHS Office of Inspector General (OIG) issued a report finding that the Administration for Children and Families (ACF) can improve services to homeless youth by strengthening grant recipients' compliance with Transitional Living Program (TLP) requirements. The audit found significant documentation gaps in service provision for a large percentage of youth served by TLP grants.

HHS OIG: Hospital Cybersecurity Controls Need Improvement

The HHS Office of Inspector General (OIG) issued a report finding that a large southeastern hospital needs to improve its cybersecurity controls, particularly for web applications. The OIG made four recommendations to enhance defenses against cyberattacks, which the hospital has concurred with.

Philadelphia K-12 Schools COVID-19 Testing Program Audit

The HHS Office of Inspector General found that Philadelphia did not consistently monitor its COVID-19 screening testing program for K-12 schools, leading to $257,620 in unallowable costs and overpayments. The OIG recommended Philadelphia update its procedures for oversight and compliance.