Reports

• Key Strategies That States Used for Managing Medicaid and Marketplace Enrollment During the COVID-19 PHE

  

• Kentucky Did Not Always Invoice Manufacturers for Rebates for Physician-Administered Drugs Dispensed to Enrollees of Medicaid Managed-Care Organizations

  

• Novitas Solutions, Inc., Claimed Some Unallowable Medicare Nonqualified Plan Costs Through Its Incurred Cost Proposals

  

• Puerto Rico Claimed Over $7 Million in Federal Reimbursement for Medicaid Capitation Payments Made on Behalf of Enrollees Who Were or May Have Been Deceased

  

• Puerto Rico Claimed More Than $500 Thousand in Unallowable Medicaid Managed Care Payments for Enrollees Assigned More Than One Identification Number

  

• Medicare Improperly Paid Acute-Care Hospitals for Inpatient Claims Subject to the Post-Acute-Care Transfer Policy Over a 4-Year Period, but CMS System Edits Were Effective in Reducing Improper Payments by the End of the Period

  

• Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients

  

• Nursing Homes Reported Wide-Ranging Challenges Preparing for Public Health Emergencies and Natural Disasters

  

• Florida Did Not Refund $106 Million Federal Share of Medicaid Managed Care Rebates It Received for Calendar Years 2015 Through 2020

  

• Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2021 Average Sales Prices

  

• Advisory Opinion 23-05

  

• Medicare Made $17.8 Million in Potentially Improper Payments for Opioid-Use-Disorder Treatment Services Furnished by Opioid Treatment Programs

  

• Office of Medicaid (MassHealth)—Review of Capitation Payments

  

• States With Separate Children Health Insurance Programs Could Have Collected an Estimated $641 Million Annually If States Were Required To Obtain Rebates Through the Medicaid Drug Rebate Program

  

• States With Separate Childrens Health Insurance Programs Could Have Collected an Estimated $641 Million Annually If States Were Required To Obtain Rebates Through the Medicaid Drug Rebate Program

  

• Office of Inspector Generals Partnership With the Commonwealth of Massachusetts Office of the State Auditor: Office of Medicaid (MassHealth)-Review of Capitation Payments

  

• Medicare Paid Independent Organ Procurement Organizations Over Half a Million Dollars for Professional and Public Education Overhead Costs That Did Not Meet Medicare Requirements

  

• Texas Inappropriately Claimed Nearly $1.8 Million in Federal Medicaid Funds for Private Medicaid Management Information System Contractor Costs

  

• Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2023

  

• Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Presbyterian Health Plan, Inc. (Contract H3204) Submitted to CMS