HHS OIG Reports & Publications

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.

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.

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.