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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.

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.

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.

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.

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.

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.