DHS -Office of Inspector General

A trusted source for Medicare news and education from the AMAC Foundation.

New Industry Segment-Specific Voluntary Compliance Program Guidance

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) has released the new industry Segment-Specific Voluntary

Eileen Cook April 1, 2026April 1, 2026 CMS, DHS -Office of Inspector General, Healthcare Finance, Medicare Advantage

Aging DHS -OIG Medicare - General Nursing Homes

Nursing homes fail to report 43% of most serious falls: HHS

(By: Elizabeth Gregerson for Becker’s Hospital Review ) Nursing homes failed to report 43% of falls that resulted in major

Eileen Cook September 25, 2025September 25, 2025 CMS, DHS -Office of Inspector General, Fail to report, Falls, medicare, Nursing Homes, Older Adults

CMS DHS -OIG Digital Technology HHS Medical Technology Medicare - General Medicare Advantage

Billing for Remote Patient Monitoring in Medicare

In 2024, Medicare paid $536 million for remote patient monitoring, a 31 percent increase from 2023. Remote patient monitoring (RPM)

Eileen Cook August 29, 2025August 29, 2025 CMS, DHS -Office of Inspector General, HHS, medicare, Medicare Advantage, Remote Patient Monitoring

DHS -OIG Medicare - General

More Medicare patients leaving hospitals against medical advice

(By: Paige Twenter for Becker’s Hospital Review ) The rate of Medicare enrollees leaving acute care hospitals against medical advice

Eileen Cook August 28, 2025August 28, 2025 Against Medical Advice, DHS -Office of Inspector General, medicare

DHS -OIG HHS Medicaid Prior Authorization

Prior Authorization Process Policies in Medicaid Managed Care: Findings from a Survey of State Medicaid Programs

(By Jada Raphael, Elizabeth Hinton, Aimee Lashbrook, and Kathleen Gifford for The Kaiser Family Foundation Published: Aug 07, 2025) Medicaid

Eileen Cook August 8, 2025August 8, 2025 DHS -Office of Inspector General, HHS, MCOs, Medicaid, Prior Authorization

CMS DHS -OIG HHS Hospice/Home Health Services Medicare Advantage

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

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

CMS DHS -OIG Health Care Finance Medicare Advantage

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)

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

CMS DHS -OIG HHS 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

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

CMS DHS -OIG Health Care Finance Medicare Advantage

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

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

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