oig.hhs.gov

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

Under the Medicare Advantage (MA) program, CMS makes monthly payments to MA organizations based in part on the health status of the enrollees being covered. To determine the health status of enrollees ...
oig.hhs.gov

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract H5216) Submitted to CMS

Under the Medicare Advantage (MA) program, CMS makes monthly payments to MA organizations based in part on the health status of enrollees being covered. To determine the health status of enrollees, ...
oig.hhs.gov

Former Owner of Telemedicine Companies Sentenced to Two Years in Prison for $110 Million Medicare Fraud Scheme

BOSTON – The former owner of Expansion Media (Expansion) and Hybrid Management Group (Hybrid) was sentenced today in federal court in Boston for a $110 million telemedicine fraud scheme involving ...
oig.hhs.gov

States Have Missed Some Opportunities to Improve Medicaid Managed Care Organizations’ Provider Fraud Referrals

Fraud in Medicaid managed care depletes critical resources and may cause harm to enrollees. State Medicaid agencies (States) play a key role in protecting taxpayer dollars by overseeing Medicaid ...
oig.hhs.gov

2026 National Health Care Fraud Takedown

The Department of Health and Human Services Office of Inspector General joined federal law enforcement partners to announce the 2026 National Health Care Fraud Takedown, which resulted in charges ...
oig.hhs.gov

CMS’s Processes Were Not Effective in Ensuring the Accuracy of Staffing Information Reported in the Payroll-Based Journal

Nursing homes are required to electronically submit to CMS's Payroll-Based Journal (PBJ) information on direct care staff (e.g., registered nurses [RNs]), including the number of hours that each staff ...
oig.hhs.gov

Attorney General Raoul Charges Former Employee Of Chicagoland Assisted-Living Facility with Sexual Abuse

Chicago – Attorney General Kwame Raoul today announced charges against a former employee of a greater-Chicago assisted-living facility for sexual abuse committed against an individual with a ...
oig.hhs.gov

CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes

Under the Medicare Advantage (MA) program, CMS makes monthly payments to MA organizations according to a system of risk adjustment that depends on the demographic characteristics and health status of ...
oig.hhs.gov

The Fraud Division Launches West Coast Strike Force to Target Health Care Fraud Schemes Across Arizona, Nevada, and Northern California

The Justice Department’s National Fraud Enforcement Division (Fraud Division) today announced the formation of the West Coast Health Care Fraud Strike Force, a multi-district enforcement initiative ...
oig.hhs.gov

Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs

Build on its efforts to reduce inappropriate schizophrenia diagnoses in nursing homes. Expand its use of data to monitor nursing homes’ use of schizophrenia diagnoses and target oversight. Increase ...
oig.hhs.gov

Forefront Living Hospice Agreed to Pay $1.9 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Identified the Incorrect ...

After it self-disclosed conduct to OIG, Forefront Living Hospice d/b/a Fatih Presbyterian Hospice and d/b/a T. Bonne Pickens Hospice and Palliative Care Center (Forefront), Dallas, Texas, agreed to ...
oig.hhs.gov

Medicare Advantage Industry Segment-Specific Compliance Program Guidance

The Medicare Advantage ICPG—together with OIG’s General Compliance Program Guidance (GCPG) that applies to all individuals and entities involved in the health care industry—serves as OIG’s updated and ...