DHS -Office of Inspector General

Thursday, April 3, 2025

Latest:

Eileen Cook November 8, 2024November 8, 2024 CMS, DHS -Office of Inspector General, Home Health Services, Medicare Advantage, Older Adults

Watchdog Calls for Tighter Scrutiny of Medicare Advantage Home Visits

(By Fred Schulte for KFF Health News) A new federal watchdog audit is ratcheting up pressure on government officials to

CMS DHS -OIG Health Care Finance Medicare Advantage

Eileen Cook October 25, 2024October 24, 2024 CMS, DHS -Office of Inspector General, Health Risk Assessments, Healthcare Finance, Medicare Advantage, Older Adults

Medicare Advantage: Questionable Use of Health Risk Assessments Continues To Drive Up Payments to Plans by Billions

(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

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 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,

DHS -OIG Health Care Finance Medicare Advantage

Eileen Cook October 6, 2023October 6, 2023 DHS -Office of Inspector General, Healthcare Finance, Medicare Advantage, Medicare Advantage Overpayments

OIG: Aetna received estimated $25.5M in Medicare Advantage overpayments

(By Rylee Wilson for Becker’s Hospital Review) Aetna received $632,070 in overpayments for Medicare Advantage claims from 2015 to 2016,

DHS -OIG Health Care Finance Medicaid

Eileen Cook July 26, 2023 0 Comments Capitation Payments, DHS -Office of Inspector General, Healthcare Finance, Medicaid, Virginia

Virginia paid $21.8M for care for Medicaid enrollees that had already died, OIG audit finds

(By Rylee Wilson for Becker’s Hospital Review) Virginia made capitation payments for thousands of Medicaid enrollees after their deaths, an

DHS -OIG Medicaid

Eileen Cook July 20, 2023 0 Comments DHS -Office of Inspector General, Medicaid Managed Care, Prior Authorization

Medicaid managed care organizations deny 1 in 8 prior authorization requests: OIG

(By Rylee Wilson for Becker’s Hospital Review) HHS’ Office of Inspector General raised concerns about the rate of prior authorization

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