Reports

• Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers

  

• Medicare Could Have Saved $301.5 Million if Bundled Payment Rates for Opioid-Use-Disorder Treatment Services Had Reflected Services Provided to Enrollees

  

• Vermont Medicaid Fraud Control Unit: 2024 Inspection

  

• HRSA Rural Communities Opioid Response Program Award Recipients Generally Met All Core Activities and Benchmarks

  

• Hospitals Charged CMS for Trauma Team Activations That Did Not Comply With Federal Requirements

  

• Deficiencies With Incorporating Required Cybersecurity Language in HHS Contracts and Timeliness of Contractor Incident Reporting

  

• Seventeen of Twenty-Five Selected Hospitals Did Not Comply or May Not Have Complied With the Provider Relief Fund Balance Billing Requirement

  

• Texas Did Not Calculate or Collect Hospice Cap Overpayments Totaling $10.5 Million

  

• New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements

  

• Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents

  

• Serious Falls Resulting in Hospitalization Among Medicare-Enrolled Nursing Home Residents, July 2022–June 2023

  

• The Patient Safety Organization Program: Key Barriers Impeding Nationwide Progress Toward Reducing Patient Harm in Hospitals

  

• Puerto Rico Medicaid Fraud Control Unit: 2024 Onsite Review

  

• Mississippi Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

  

• Hawaii Did Not Ensure That Selected Nursing Facilities Complied With Federal and State Background Check Requirements

  

• Most Children Enrolled in Medicaid Did Not Receive Timely Suicide-Related Followup Care

  

• Medicare Part B Payment Trends for Skin Substitutes Raise Major Concerns About Fraud, Waste, and Abuse

  

• By Requiring Emergency Preparedness Plans for Independent Labs, CMS Could Better Ensure That Medicare Enrollees Have Access to Infectious-Disease Diagnostic Testing During a Public Health Emergency

  

• ACF Did Not Award, Monitor, and Close Selected Contracts for the Unaccompanied Alien Children Program in Accordance With Federal Requirements

  

• Some Medicaid Managed Care Plans Made Few or No Referrals of Potential Provider Fraud