Reports

• 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

  

• Medicare Payments for Positive Airway Pressure Devices Used for the Treatment of Obstructive Sleep Apnea Generally Complied With Medicare Requirements

  

• CMS Has Limited Oversight of Selected Compounded Drugs Prescribed to Medicare Part D Enrollees

  

• Vibrent Health Claimed Unallowable Costs Under a National Institutes of Health Other Transaction Award

  

• Louisiana Healthcare Connections Generally Complied With Federal and State Process Requirements When Denying Prior Authorization Requests

  

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Priority Health (Contract H2320) Submitted to CMS

  

• Medicare Home Health Agency Provider Compliance Audit: VNS Health

  

• Selected Diabetes and Weight Loss Drugs Were Dispensed to Michigan Medicaid Managed Care Enrollees in Accordance With Federal and State Requirements

  

• Congressional Mandate: Part B Payment Amounts for One Drug Included Noncovered Self-Administered Versions in 2024

  

• Review of the Department of Health and Human Services’ Compliance With the Federal Information Security Modernization Act of 2014 for Fiscal Year 2025

  

• Medicaid Fraud Control Units Annual Report: Fiscal Year 2025

  

• Indiana Generally Ensured That Selected Nursing Homes Complied With Federal Background Check Requirements

  

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

  

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Gateway Health Plan, Inc., (Contract H5932) Submitted to CMS

  

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Blue Cross and Blue Shield of Alabama (Contract H0104) Submitted to CMS