DHS -OIG – medicarereport.org

(Source – oig.hhs.gov) Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS)

CMS DHS -OIG HHS Medicare Advantage Prior Authorization

Eileen Cook July 8, 2024 CMS, Deny Post-Acute Care, DHS -Office of Inspector General, Medicare Advantage, Medicare Advantage Prior Authorization

OIG to probe whether Medicare Advantage plans deny post-acute care

(By Rylee Wilson for Becker’s Hospital Review) HHS’ Office of Inspector General will audit Medicare Advantage plans’ use of prior

DHS -OIG Health Care Finance Medicaid

Eileen Cook June 6, 2024June 6, 2024 DHS-OIG, Medicaid, Noncitizens, nonemergency care

California to repay $52M spent on Medicaid for noncitizens

(By Rylee Wilson for Becker’s Hospital Review) California improperly used $52.7 million in federal Medicaid funds to pay for nonemergency

CMS DHS -OIG Health Care Finance Medicare Advantage

Eileen Cook December 5, 2023December 5, 2023 CMS, DHS -Office of Inspector General, Healthcare Costs, Healthcare Finance, Medicare Advantage, Medicare Advantage Audits, Medicare Advantage Overpayments

10 payers audited for Medicare Advantage overpayments in 2023

(By Rylee Wilson for Becker’s Hospital Review) OIG audits found over $213 million in estimated Medicare Advantage overpayments in 2023.

DHS -OIG Medicare Advantage

Eileen Cook December 4, 2023December 4, 2023 CMS, DHS -Office of Inspector General, Medicare Advantage, Medicare Advantage Overpayments

OIG: Centene subsidiary received estimated $5.1M in Medicare Advantage overpayments

(By Rylee Wilson for Becker’s Hospital Review) SelectCare of Texas, a Centene subsidiary, received an estimated $5.1 million in net

CMS DHS -OIG Medicaid

Eileen Cook December 1, 2023December 1, 2023 CMS, Deceased Medicaid Enrollees, DHS-OIG, HHS Inspector General's Office Audit, Improper Payments, Medicaid, Medicaid Managed Care

OIG: 14 states paid managed care organizations $249M for deceased Medicaid enrollees

(By Rylee Wilson for Becker’s Hospital Review) Fourteen states gave managed care organizations payments for Medicaid enrollees for months after

CMS DHS -OIG Health Care Finance HHS Medicare Advantage Medicare Fraud; Illegal Activities

Eileen Cook November 13, 2023November 13, 2023 CMS, DHS -Office of Inspector General, False Claims Act, Healthcare Costs, Medicare Advantage

Feds ramp up Medicare Advantage scrutiny

(By Rylee Wilson for Becker’s Hospital Review) The federal government is ramping up scrutiny of Medicare Advantage plans. In October,

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