Reports

• North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings 

  

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

  

• Jefferson Regional Medical Center Received at Least $4.7 Million in Medicare Overpayments

  

• Inaccurate Medicaid Managed Care Network Lists May Compromise State Oversight of Access to Maternal Health Care

  

• Inaccurate Medicaid Managed Care Provider Directories May Limit Enrollees’ Access to Maternal Health Care 

  

• Community Behavioral Health Did Not Comply With Requirements When Denying Prior Authorization Requests

  

• A Small Southeastern Hospital Had Effective Cybersecurity Controls To Prevent, Detect, and Respond To Cyberattacks

  

• Congressional Mandate: Part B Billing Codes for Six Drugs Included Noncovered Self-Administered Versions During January 2025 - March 2026

  

• Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials

  

• The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates

  

• California Made at Least $13.9 Million More in Medicaid Reimbursements for Clinical Diagnostic Laboratory Services Than Was Allowed by Federal and State Requirements

  

• The Office of Refugee Resettlement Needs To Improve Its Monitoring of Unlicensed Unaccompanied Alien Children Program Care Providers’ Compliance With Background Check Requirements

  

• CMS Should Improve Its Policies and Procedures for the Oversight of States’ Reported Medicaid Expenditures to Better Protect the Financial Integrity of the Medicaid Program

  

• Lehigh Valley Hospital Received At Least $17.8 Million in Medicare Overpayments

  

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

  

• Connecticut Did Not Always Ensure Selected Nursing Homes Complied With Federal and State Background Check Requirements

  

• Unclear Medicare Requirements Led to Differing Interpretations of Inpatient Rehabilitation Facility Documentation, Coverage, and Billing Requirements

  

• Impacts of Vertical Integration in Medicare Part D on Sponsors Drug Costs, Pharmacy Reimbursement, and Enrollee Cost Sharing

  

• Most Nursing Homes Throughout the United States Do Not Have Adequate or Reliable Emergency Power Systems

  

• CMS Could Strengthen Medicare Program Safeguards To Prevent and Detect Potentially Improper Payments for Virtual Check-in and E-visit Services