Agency · HHS OIG

OIG Report (Audit): South Carolina Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

OIG Report (Audit): Medicare Advantage Organizations and Prescription Drug Plans Paid $72 Million During a 3-Year Period for Services Associated With Excluded Providers or Individuals Convicted of Certain Felonies

ECU Health North Hospital Agreed to Pay $200,000 for Allegedly Violating Patient Dumping Statute by Failing to Provide Appropriate Medical Screening Examinations

Updated Heightened Scrutiny: Negril Incorporated

Seoul Medical Group Agreed to Pay $100,000 for Allegedly Violating the Civil Monetary Penalties Law by Paying Improper Remuneration to Insurance Brokers

OIG Report (Audit): California Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

Baptist Health Brookwood Hospital Agreed to Pay $105,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims that Failed to Meet Coverage Criteria

OIG Report (Audit): Methodist Hospital Received at Least $12.4 Million in Medicare Overpayments

Khadeer Khan Mohammed

Whitesburg ARH Hospital Agreed to Pay $5.8 Million for Allegedly Violating the Civil Monetary Penalties Law by Paying Improper Remuneration in the Form of Staff Costs

Medina Valley Agreed to Pay $455,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

OIG Report (Audit): Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program

AO 26-18

OIG Report (Audit): CMS Oversight Did Not Prevent Medicare Part D Sponsors From Making $587.7 Million in Ineligible Payments to Pharmacies for Drugs Available Over the Counter but Labeled as Prescription-Only

Updated Health Care Fraud Self-Disclosure Protocol

Pyramid Healthcare Agreed to Pay $546,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Liberty County Hospital District No 1 and PF Carthage SNF Ops Agreed to Pay $525,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

OIG Report (Audit): Kentucky Could Better Protect Children Residing in Qualified Residential Treatment Programs

OIG Report (Audit): Connecticut Could Better Ensure That the Department of Developmental Services and Providers Fully Comply With Federal Waiver and State Health and Safety Requirements for Individualized Home Support Services

Suburban Hospital Agreed to Pay $28,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Northwestern McHenry Hospital Agreed to Pay $112,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

The Johns Hopkins Hospital and The Johns Hopkins Health System Agreed to Pay $175,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

Bayside Care Center Agreed to Pay $38,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

Bridge Crest Post Acute Agreed to Pay $43,000 fo r Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

Capital Senior Living, CSL Riverbend IN, and Capital Senior Living Properties Agreed to Pay $127,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

OIG Report (OEI): Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted Medical Loss Ratio Data Has Limitations

Mulder Health Care Agreed to Pay $93,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

The Josselyn Center Agreed to Pay $20,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Not Provided

Fairlane Gardens Skilled Nursing and Rehabilitation Center Agreed to Pay $131,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

OIG Report (Audit): Conflicting CMS Guidance and Federal Statutory Requirements Cost Medicare $380 Million Over a 6-Year Period for Organs Not Transplanted Into Medicare Enrollees

A&M Medical Services Agreed to Pay $302,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Ambulance Transports Not Properly Staffed

OIG Work Plan: GLP‑1 Overdispensing in Part D

Dialysis Care Center Agreed to Pay $254,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

OIG Work Plan: MAOs’ Use of Prior Authorization for Part B Drugs

OIG Report (Audit): CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys

Cy-Fair Fire Department Agreed to Pay $94,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services Provided by an Unlicensed Individual

Friendship Community Care Agreed to Pay $21,000 for Allegedly Violating the Civil Monetary Penalties Law by Employing an Excluded Individual

OIG Report (OEI): Alabama Medicaid Fraud Control Unit: 2025 Inspection

OIG Report (Audit): Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), Submitted to CMS

OIG Report (OEI): Medicare Advantage Organizations and CMS Can Do More To Prevent Durable Medical Equipment Fraud in Medicare Advantage

OIG Report (Audit): New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees

OIG Report (Audit): Tennessee Claimed Federal Medicaid Reimbursement for Millions of Dollars in Targeted Case Management Services That Did Not Comply With Federal and State Requirements

Findings of Whistleblower Retaliation by Indian Health Service Contractor Management

CMP and Affirmative Exclusions, EMTALA/Patient Dumping, and Self-Disclosures

OIG Report (OEI): North Dakota Medicaid Fraud Control Unit: 2025 Inspection

OIG Report (Audit): Many Independent Organ Procurement Organizations Did Not Meet Medicare Requirements for Reporting Kidney Transportation Costs and Some Did Not Transport Organs in Accordance With Medicare Requirements

OIG Report (Audit): Medicare Hospital Provider Compliance Audit: McLeod Regional Medical Center

OIG Report (OEI): North Carolina Medicaid Fraud Control Unit: 2025 Onsite Inspection

OIG Report (OEI): Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2024 Average Sales Prices