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Centers for Medicare and Medicaid Services (CMS)

CMS Document Archive

2020

12-07-2020: Medicare Home Health Agency Provider Compliance Audit: Total Patient Care Home Health, LLC A-06-16-05005
12-11-2020: Risk Assessment Puerto Rico Medicaid Program A-02-20-01011
12-09-2020: New York Improved Its Monitoring of Its Personal Care Services Program But Still Made Improper Medicaid Payments of More Than $54 Million A-02-19-01016
12-01-2020: Nebraska Claimed Almost All Medicaid Payments for Targeted Case Management Services in Accordance With Federal Requirements but Claimed Some Unallowable Duplicate Payments A-07-19-03239
11-24-2020: Florida Received Unallowable Medicaid Reimbursement for School-Based Services A-04-18-07075
11-19-2020: Medicare Hospice Provider Compliance Audit: Hospice Compassus, Inc., of Payson, Arizona. A-02-16-01023
11-18-2020: Medicare Home Health Agency Provider Compliance Audit: The Palace at Home A-04-17-07067
11-17-2020: Cahaba Government Benefits Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00577; Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs Through Its Incurred Cost Proposals A-07-19-00578
11-16-2020: Hospitals Did Not Comply With Medicare Requirements for Reporting Cardiac Device Credits A-01-18-00502
11-12-2020: Ohio Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State A-05-19-00023; Medicare Hospital Provider Compliance Audit: Edward W. Sparrow Hospital A-05-18-00045
11-10-2020: Ohio Did Not Correctly Determine Medicaid Eligibility for Some Newly Enrolled Beneficiaries A-05-18-00027
11-05-2020: Cahaba Government Benefits Administrators, LLC, Did Not Claim Some Allowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00575; Cahaba Safeguard Administrators, LLC, Claimed Some Unallowable Medicare Pension Costs Through Its Incurred Cost Proposals A-07-19-00576
11-04-2020: CMS Did Not Ensure That Medicare Hospital Payments for Claims That Included Medical Device Credits Were Reduced in Accordance With Federal Regulations, Resulting in as Much as $35 Million in Overpayments A-07-19-00560
10-29-2020: Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Central Jersey Home Care and Hospice, Inc. A-02-17-01025
10-22-2020: Massachusetts Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-06-18-04001
10-21-2020: Minnesota Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00018
10-16-2020: Medicare Home Health Agency Provider Compliance Audit: Gem City Home Care, LLC A-05-18-00011; Medicare Hospital Provider Compliance Audit: St Francis Hospital A-05-18-00048
10-14-2020: Cedars-Sinai Medical Center: Audit of Medicare Payments for Bariatric Surgeries A-09-18-03010
10-09-2020: Medicare Improperly Paid Physicians for More Than Five Spinal Facet-Joint Injection Sessions During a Rolling 12-Month Period A-09-20-03003
10-07-2020: Update on Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic A-09-20-01000
10-02-2020: Colorado Improperly Claimed Millions in Enhanced Federal Medicaid Reimbursement for New Adult Group Beneficiaries Because of a Data Processing Error A-07-17-02807; Medicare Critical Care Services Provider Compliance Audit: Clinical Practices of the University of Pennsylvania A-03-18-00003
09-30-2020: Medicare Hospital Provider Compliance Audit: Alta Bates Summit Medical Center A-04-19-08071
09-25-2020: North Carolina Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-04-16-00112
09-22-2020: Oregon's Oversight Did Not Ensure That Four Coordinated-Care Organizations Complied With Selected Medicaid Requirements Related to Access to Care and Quality of Care A-09-18-03035; CMS's Monitoring Activities for Ensuring That Medicare Accountable Care Organizations Report Complete and Accurate Data on Quality Measures Were Generally Effective, but There Were Weaknesses That Could Be Improved A-09-18-03033
09-21-2020: Connecticut Did Not Meet Federal and State Requirements for Claiming Medicaid School-Based Child Health Services for Hartford Public Schools A-01-19-00003
09-18-2020: North Carolina Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-19-08070; Vermont Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-19-06086
09-17-2020: Illinois Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-05-18-00037
09-16-2020: Incorrect Acute Stroke Diagnosis Codes Submitted by Traditional Medicare Providers Resulted in Millions of Dollars in Increased Payments to Medicare Advantage Organizations A-07-17-01176; Medicare-Allowed Charges for Noninvasive Ventilators Are Substantially Higher Than Payment Rates of Select Non-Medicare Payers A-05-20-00008; Noridian Healthcare Solutions, LLC, Claimed Some Unallowable Medicare Nonqualified Plans Costs Through Its Incurred Cost Proposals A-07-20-00590
09-14-2020: Maine Did Not Always Invoice Rebates to Manufacturers for Physician-Administered Drugs A-07-18-06079
09-11-2020: Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services A-05-18-00035; Group Health Incorporated Overstated Its Allowable Medicare Supplemental Executive Retirement Plan Costs for Calendar Years 2009 Through 2016 A-07-19-00582; Group Health Incorporated Claimed Some Unallowable Medicare Postretirement Benefit Costs for Calendar Years 2009 Through 2016 A-07-19-00583; Group Health Incorporated Overstated Its EmblemHealth Services Company, LLC, Employees' Retirement Plan Medicare Segment Pension Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of December 31, 2015 A-07-19-00579; Group Health Incorporated Overstated Its Local 153 Pension Plan Medicare Segment Assets and Understated Medicare's Share of the Medicare Segment Pension Assets as of August 31, 2016 A-07-19-00580; Group Health Incorporated Did Not Claim Some Allowable Medicare Pension Costs for Calendar Years 2009 Through 2016 A-07-19-00581
09-08-2020: Indiana Did Not Ensure That Medicaid Payments Were Made Properly for Some Claims Identified as Having Third-Party Coverage A-05-18-00046
09-04-2020: Audit of Medicare Part D Pharmacy Fees: Horizon Blue Cross Blue Shield, Inc. A-03-18-00007
09-03-2020: Baylor Scott & White—College Station: Audit of Outpatient Outlier Payments A-06-18-04003
09-01-2020: Colorado Claimed Unsupported and Incorrect Federal Medicaid Reimbursement for Beneficiaries Enrolled in the New Adult Group A-07-19-02822; Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center A-07-18-05112
08-27-2020: Texas Relied on Impermissible Provider-Related Donations To Fund the State Share of the Medicaid Delivery System Reform Incentive Payment Program A-06-17-09002
08-25-2020: Michigan Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-05-17-00017; Illinois Claimed Unallowable Telemedicine Payments A-05-18-00028; Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements A-05-18-00043; Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process A-05-18-00024
08-21-2020: CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete A-05-16-00051
08-19-2020: New Jersey Did Not Ensure That Incidents of Potential Abuse or Neglect of Medicaid Beneficiaries Residing in Nursing Facilities Were Always Properly Investigated and Reported A-02-18-01006
08-18-2020: Indiana Properly Reported Adjustments Related to the Drug Rebate Program A-05-19-00028
08-14-2020: Nebraska Claimed Unallowable School-Based Administrative Costs Because of Improper Coding of Random Moment Timestudy Responses A-07-19-03234
08-11-2020: Medicare Home Health Agency Provider Compliance Audit: Mission Home Health of San Diego, Inc. A-09-18-03008
08-10-2020: Visionquest Industries, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03010; Medicare Home Health Agency Provider Compliance Audit: Condado Home Care Program, Inc. A-02-17-01022
08-06-2020: Desoto Home Health Care, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03021
08-05-2020: Inadequate Edits and Oversight Caused Medicare To Overpay More Than $267 Million for Hospital Inpatient Claims With Post-Acute-Care Transfers to Home Health Services A-04-18-04067
08-04-2020: Review of Medicare Administrative Contractor Information Security Program Evaluations for Fiscal Year 2019 A-18-20-11300
07-29-2020: North Carolina Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse and Neglect of Medicaid Beneficiaries and Did Not Always Prioritize Allegations Timely A-04-17-04063
07-27-2020: The New York State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-04-19-06223
07-24-2020: Factsheet: Ohio's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-05-19-00036
07-22-2020: CMS Could Have Saved $192 Million by Targeting Home Health Claims for Review With Visits Slightly Above the Threshold That Triggers a Higher Medicare Payment A-09-18-03031
07-21-2020: On-Site Psychological Services, P.C.: Audit of Medicare Payments for Psychotherapy Services A-02-19-01012; Alaska Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-09-19-02001
07-15-2020: CMS Did Not Administer and Manage Strategic Communications Services Contracts in Accordance With Federal Requirements A-12-19-20003
07-13-2020: Hospitals Overbilled Medicare $1 Billion by Incorrectly Assigning Severe Malnutrition Diagnosis Codes to Inpatient Hospital Claims A-03-17-00010
07-10-2020: Medicaid Data Can Be Used To Identify Instances of Potential Child Abuse or Neglect A-01-19-00001
07-09-2020: Texas Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-06-17-04003
07-06-2020: Freedom Orthotics, Inc.: Audit of Medicare Payments for Orthotic Braces A-09-19-03012
06-03-2020: Texas Telemedicine Services Were Provided in Accordance with State Requirements A-06-18-05001
06-01-2020: New Jersey Did Not Ensure That Its Managed Care Organizations Adequately Assessed and Covered Medicaid Beneficiaries' Needs for Long-Term Services and Supports A-02-17-01018
05-22-2020: Medicare Hospital Provider Compliance Audit: The Ohio State University Hospital A-05-18-00042
05-01-2020: Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays A-01-17-00508
04-29-2020: North Carolina Received $30 Million in Excess Federal Funds Related to Improperly Claimed Health Home Expenditures A-04-18-00120
04-20-2020: Grand Desert Psychiatric Services: Audit of Medicare Payments for Psychotherapy Services A-09-19-03018
04-17-2020: Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Postretirement Benefit Costs A-07-20-00589; Palmetto Government Benefits Administrator, LLC, Claimed Some Unallowable Medicare Pension Costs A-07-20-00588; Companion Data Services, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00587; Palmetto Government Benefits Administrator, LLC, Overstated Its Medicare Segment Pension Assets as of January 1, 2017 A-07-20-00586
04-16-2020: Recommendation Followup: Michigan Did Not Report and Refund the Full Federal Share of Medicaid Overpayments A-05-18-00022
04-09-2020: Medicare Home Health Agency Provider Compliance Audit: Residential Home Health A-05-16-00063; An Estimated 87 Percent of Inpatient Psychiatric Facility Claims With Outlier Payments Did Not Meet Medicare's Medical Necessity or Documentation Requirements A-01-16-00508
04-07-2020: New York Did Not Bill Manufacturers for Some Rebates for Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations A-02-18-01016; Iowa Inadequately Monitored Its Medicaid Health Home Providers, Resulting in Tens of Millions in Improperly Claimed Reimbursement A-07-18-04109
04-01-2020: 96 Percent of South Carolina's Medicaid Fee-for-Service Telemedicine Payments Were Insufficiently Documented or Otherwise Unallowable A-04-18-00122
03-27-2020: Medicare Hospital Provider Compliance Audit: Forbes Hospital A-03-18-00005; Iowa Did Not Comply With Federal and State Requirements for Major Incidents Involving Medicaid Members With Developmental Disabilities A-07-18-06081
03-26-2020: New York's Oversight of Medicaid Managed Care Organizations Did Not Ensure Providers Complied With Health and Safety Requirements at 18 of 20 Adult Day Care Facilities Reviewed A-02-18-01027
03-25-2020: Medicare Dialysis Services Provider Compliance Review: Bio-Medical Applications of Arecibo, Inc. A-02-17-01016
03-24-2020: Most of the Non-Newly Eligible Beneficiaries for Whom Colorado Made Medicaid Payments Met Federal and State Requirements, but Documentation Supporting That All Eligibility Requirements Were Verified Properly Was Not Always in Place A-07-18-02812
03-23-2020: Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers A-04-18-07080
03-17-2020: CMS Could Take Actions To Help States Comply With Federal Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions A-09-18-02004
03-13-2020: Missouri Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-07-18-03230
03-06-2020: Florida Should Improve Its Oversight of Selected Nursing Homes' Compliance With Federal Requirements for Life Safety and Emergency Preparedness A-04-18-08065
03-03-2020: Factsheet: Kentucky's Oversight of Opioid Prescribing and Monitoring of Opioid Use A-04-19-02022
03-02-2020: Medicare Hospital Provider Compliance Audit: Saint Francis Health Center A-07-17-05102
02-28-2020: The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act A-03-16-03001
02-25-2020: CHI St. Vincent Infirmary: Audit of Outpatient Outlier Payments A-06-16-01002
02-20-2020: New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers A-02-18-01020
02-19-2020: New York Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs A-02-18-01011
02-14-2020: Michigan Made Capitation Payments to Managed Care Entities After Beneficiaries' Deaths A-05-17-00048
02-11-2020: The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes A-05-17-00020
02-07-2020: The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs A-09-18-01000
02-06-2020: New York Followed Its Approved Methodology for Claiming Enhanced Medicaid Reimbursement Under the Community First Choice Option A-02-17-01015
02-06-2020: Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes A-06-19-08001
02-04-2020: New York Claimed Tens of Millions of Dollars for Opioid Treatment Program Services That Did Not Comply With Medicaid Requirements Intended To Ensure the Quality of Care Provided to Beneficiaries A-02-17-01021; 01-29-2020; The Indiana State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries' Deaths A-05-19-00007
01-24-2020: More Than One-Third of New Jersey's Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable A-02-17-01020
01-21-2020: CMS's Implementation of a 2014 Policy Change Resulted in Improvements in the Reporting of Coverage Gap Discounts Under Medicare Part D A-07-16-06067
01-17-2020: Pennsylvania Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities A-03-17-00202
01-13-2020: CMS's Controls Over Assigning Medicare Beneficiary Identifiers and Mailing New Medicare Cards Were Generally Effective but Could Be Improved in Some Areas A-09-19-03003
01-09-2020: New York Improperly Claimed Medicaid Reimbursement for Some Bridges to Health Waiver Program Services That Were Not in Accordance With an Approved Plan of Care and Did Not Meet Documentation Requirements A-02-18-01003