Reports

• Advisory Opinion 21-03

  

• U.S. Department of Health and Human Services Met Many Requirements, but It Did Not Fully Comply With the Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for Fiscal Year 2020

  

• CMS Needs to Strengthen Regulatory Requirements for Medicare Part B Outpatient Cardiac and Pulmonary Rehabilitation Services to Ensure Providers Fully Meet Coverage Requirements

  

• Minnesota Made Capitation Payments to Managed Care Organizations for Medicaid Beneficiaries With Concurrent Eligibility in Another State

  

• New York Made Unallowable Payments Totaling More Than $9 Million to the Same Managed Care Organization for Beneficiaries Assigned More Than One Medicaid Identification Number

  

• Medicare Could Have Saved up to $20 Million Over 5 Years if CMS Oversight Had Been Adequate To Prevent Payments for Medically Unnecessary Cholesterol Blood Tests

  

• Medicare Hospice Provider Compliance Audit: Suncoast Hospice

  

• Louisiana Did Not Fully Comply With Federal and State Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With Developmental Disabilities

  

• CMS Could Improve the Data It Uses To Monitor Antipsychotic Drugs in Nursing Homes

  

• Medicare Hospital Provider Compliance Audit: Virtua Our Lady of Lourdes Hospital

  

• Medicare Home Health Agency Provider Compliance Audit: Visiting Nurse Association of Maryland

  

• Advisory Opinion 21-02

  

• Louisiana Appropriately Claimed Most Balancing Incentive Payment Program Funds

  

• Medicare Advantage Compliance Audit of Diagnosis Codes That Humana, Inc., (Contract H1036) Submitted to CMS

  

• Blue Cross Blue Shield of South Carolina Overstated Its Supplemental Executive Retirement Plan III Medicare Allowable Segment Pension Assets as of January 1, 2017

  

• Palmetto Government Benefits Administrator, LLC, Overstated Its Excess Plan Medicare Segment Pension Assets as of January 1, 2017

  

• Noridian Healthcare Solutions, LLC, Claimed Unallowable Medicare Nonqualified Restoration Savings Plan Costs Through Its Incurred Cost Proposals

  

• Medicare Advantage Organizations Are Missing Opportunities To Use Ordering Provider Identifiers To Protect Program Integrity

  

• Medicare Hospital Provider Compliance Audit: Sunrise Hospital & Medical Center

  

• An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis