We recommend that the Indian Health Service correct Purpose Statute violations totaling $19,912 relating to funds not used on COVID-19 testing and other testing-related activities from the Pine Ridge Service Unit (an IHS Direct program), and, if IHS is unable to correct those violations, report any Antideficiency Act violations.

23-A-07-091.02 - Open

We recommend that the Indian Health Service identify and correct any other Purpose Statute violations relating to funds not used on COVID-19 testing and other testing-related activities from the Families First Act and Paycheck Protection Act funds allocated to the IHS Direct programs within the GPAO, and, if IHS is unable to correct those violations, report any Antideficiency Act violations.

23-A-07-091.03 - Open

We recommend that the Indian Health Service recover $460,525 in funds not used on COVID-19 testing and other testing-related activities from the applicable sampled Tribal and UIO programs.

23-A-07-091.04 - Open

We recommend that the Indian Health Service identify and recover amounts not used for COVID-19 testing or other testing-related activities that we did not sample from remaining Tribal and UIO programs within the GPAO.

23-A-07-091.05 - Open

We recommend that the Indian Health Service develop and implement procedures to identify and deobligate any unused Families First Act funds that expired on September 30, 2022, from all locations within the GPAO.

23-A-07-091.06 - Open

We recommend that the Indian Health Service develop and provide adequate guidance to programs within the GPAO on the proper use of Paycheck Protection Act funds in accordance with Federal requirements.

23-A-07-091.07 - Open

We recommend that the Indian Health Service strengthen its review process to ensure that modifications to ISDEAA agreements and IHCIA/FAR contracts contain complete and accurate information, including the funding source, amount awarded, and applicable language required under the funding source.

23-A-07-091.08 - Open

We recommend that the Indian Health Service provide adequate guidance to the programs on how to track and account for funds allocated and used under the Paycheck Protection Act.

23-A-07-091.09 - Open

We recommend that the Indian Health Service work with Tribal and UIO programs within the GPAO that we did not sample to ensure that they have properly tracked and accounted for funds used under the Paycheck Protection Act.

Department of Health & Human Services OIG

HRSA Made COVID-19 Uninsured Program Payments to Providers on Behalf of Individuals Who Had Health Insurance Coverage and for Services Unrelated to COVID-19

Full Details: Oversight.gov Report Page

Audit | 7/13/2023

Department of Health & Human Services OIG

Alaska Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Audit | 6/02/2023

Department of Health & Human Services OIG

Seventeen of Thirty Selected Health Centers Did Not Use or May Not Have Used Their HRSA COVID-19 Supplemental Grant Funding in Accordance With Federal Requirements

Full Details: Oversight.gov Report Page

Audit | 5/18/2023

Department of Health & Human Services OIG

Montana Generally Complied With Requirements for Telehealth Services During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Audit | 5/17/2023

Department of Health & Human Services OIG

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency

Full Details: Oversight.gov Report Page

Audit | 5/02/2023

23-A-09-068.01 - Open

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to recover $35,560 in improper payments made to providers for the 128 sampled enrollee days that did not meet Medicare requirements.

23-A-09-068.02 - Closed

We recommend that the Centers for Medicare & Medicaid Services work with the MACs to based upon the results of this audit, notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.

23-A-09-068.03 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Conduct medical reviews of psychotherapy services, including services provided via telehealth, to verify that the services are documented and billed in accordance with Medicare requirements.

23-A-09-068.04 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Implement system edits for psychotherapy services, including services provided via telehealth, to prevent payments for services that were billed incorrectly.

23-A-09-068.05 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Strengthen educational efforts to make providers aware of educational materials on how to meet Medicare requirements and guidance for psychotherapy services, including services provided via telehealth.

23-A-09-068.06 - Open

Now that CMS has reinstituted most program integrity measures, we also recommend that CMS work with the MACs to take the following steps, which if in effect during the audit period could have saved Medicare an estimated $579,667,510 during that period: Review MAC jurisdictions' LCD requirements for psychotherapy services to identify which provisions effectively promote program integrity, and consider additional steps that CMS could undertake to ensure appropriate coverage and payment for psychotherapy services across all jurisdictions.

Department of Health & Human Services OIG

ASPR Could Improve Its Oversight of the Hospital Preparedness Program To Ensure That Crisis Standards of Care Comply With Federal Nondiscrimination Laws

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19

Full Details: Oversight.gov Report Page

Audit | 12/21/2022

Department of Health & Human Services OIG

The Number of Beneficiaries Who Received Medicare Part B Clinical Laboratory Tests Decreased During the First 10 Months of the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Payments Made to Providers Under the COVID-19 Accelerated and Advance Payments Program Were Generally in Compliance With the CARES Act and Other Federal Requirements

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

IHS Did Not Always Provide the Necessary Resources and Assistance To Help Ensure That Tribal Programs Complied With All Requirements During Early COVID-19 Vaccination Program Implementation

Full Details: Oversight.gov Report Page

Audit | 10/17/2022

Department of Health & Human Services OIG

National Snapshot of Trends in the National Domestic Violence Hotlines Contact Data Before and During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic

On March 13, 2020, the President of the United States declared that the COVID-19 pandemic was a national emergency. That same day, in accordance with section 1135(b) of the Social Security Act (the Act), the Secretary of HHS invoked his authority to waive or modify certain requirements of Titles XVIII, XIX, and XXI of the Act. To limit the spread of the virus, Federal, State and local governments urged individuals to stay at home and for individuals who test positive to quarantine, among other preventive measures. As a result, the usual and customary ways that many individuals obtained...

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic

Full Details: Oversight.gov Report Page

Department of Health & Human Services OIG

CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data

The United States currently faces a nationwide public health emergency because of the COVID-19 pandemic. Federal regulations, effective May 8, 2020, required nursing homes to report COVID-19 information, such as the number of confirmed COVID-19 cases among residents, at least weekly to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network. Each week, CDC aggregates the reported information and sends the data to the Centers for Medicare & Medicaid Services (CMS) for posting to the CMS website. These data are used to assist with national surveillance of...

Full Details: Oversight.gov Report Page

Audit | 9/01/2021

271069 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to develop a process to identify nursing homes that do not report required data for all of the data elements related to COVID-19 cases and deaths among residents and staff and PPE and supplies and request that they submit the required data.

271070 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to revise its quality assurance checks for ratios 1, 3, 5, and 6, which use the number of all beds in the denominator, to ensure that it does not exclude from its COVID-19 data nursing homes' data that should be included.

271071 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to revise its quality assurance checks for ratios 2 and 4, which use the numbers of confirmed cases and admissions among residents and confirmed cases among staff in the denominator, by adding the number of suspected COVID-19 cases to the denominator in both ratios and adjust the ratios' thresholds to reflect the change.

271072 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to identify the nursing homes that reported more total COVID-19 deaths than total deaths from any cause and request that they verify or correct the reported data.

271073 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to contact nursing homes that failed quality assurance checks to verify the accuracy of reported data or to correct inaccurate data.

271074 - Closed

We recommend that the Centers for Medicare & Medicaid Services assess the costs and benefits of implementing the following recommendations and if CMS determines that the benefits outweigh the costs, take action to work with CDC and with State health departments to determine the feasibility of using comparable data elements to collect COVID-19 data and the feasibility of monitoring substantial differences in the data and, if determined feasible, take actions to provide the public with more complete and accurate COVID-19 data for nursing homes.

Department of Health & Human Services OIG

CMS’s Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals

Hospitals that cannot control the spread of emerging infectious diseases within their facilities risk spreading a disease such as COVID-19 to patients and staff. OIG therefore developed a plan to assess the Centers for Medicare & Medicaid Services’ (CMS’s) controls related to hospital preparedness for emerging infectious diseases.The objective of this audit was to determine whether CMS designed and implemented effective internal controls related to hospital preparedness for emerging infectious diseases such as COVID-19.

Full Details: Oversight.gov Report Page

Audit | 6/24/2021

Department of Health & Human Services OIG

Date Range

Report Category

Submitting Agency

Any Recommendations

Any Open Recommendations

Reports

Medicare Generally Paid Acute-Care Hospitals for Inpatient Stays for Medicare Enrollees Diagnosed With COVID-19 in Accordance With Federal Requirements

Kentucky Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic

New York City Department of Health and Mental Hygiene Charged Some Unallowable Costs to Its CDC COVID-19 Award

CDC's Internal Control Weaknesses Led to Its Initial COVID-19 Test Kit Failure, but CDC Ultimately Created a Working Test Kit

The Strategic National Stockpile Was Not Positioned To Respond Effectively to the COVID-19 Pandemic

CDC Provided Oversight and Assistance; However, ELC Recipients Still Faced Challenges in Implementing COVID-19 Screening Testing Programs

Home Health Agencies Rarely Furnished Services Via Telehealth Early in the COVID-19 Public Health Emergency

Four States Reviewed Received Increased Medicaid COVID-19 Funding Even Though They Terminated Some Enrollees' Coverage for Unallowable or Potentially Unallowable Reasons

Telehealth During 2020 Helped Ensure End-Stage Renal Disease Patients Received Care, But Limited Information Related to Telehealth Was Documented

Although IHS Allocated COVID-19 Testing Funds To Meet Community Needs, It Did Not Ensure That the Funds Were Always Used in Accordance With Federal Requirements

HRSA Made COVID-19 Uninsured Program Payments to Providers on Behalf of Individuals Who Had Health Insurance Coverage and for Services Unrelated to COVID-19

Alaska Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic

Seventeen of Thirty Selected Health Centers Did Not Use or May Not Have Used Their HRSA COVID-19 Supplemental Grant Funding in Accordance With Federal Requirements

Montana Generally Complied With Requirements for Telehealth Services During the COVID-19 Pandemic

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency

ASPR Could Improve Its Oversight of the Hospital Preparedness Program To Ensure That Crisis Standards of Care Comply With Federal Nondiscrimination Laws

Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19

The Number of Beneficiaries Who Received Medicare Part B Clinical Laboratory Tests Decreased During the First 10 Months of the COVID-19 Pandemic

Payments Made to Providers Under the COVID-19 Accelerated and Advance Payments Program Were Generally in Compliance With the CARES Act and Other Federal Requirements

IHS Did Not Always Provide the Necessary Resources and Assistance To Help Ensure That Tribal Programs Complied With All Requirements During Early COVID-19 Vaccination Program Implementation

National Snapshot of Trends in the National Domestic Violence Hotlines Contact Data Before and During the COVID-19 Pandemic

Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic

Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic

CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data

CMS’s Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals

Opioid Treatment Programs Reported Challenges Encountered During the COVID-19 Pandemic and Actions Taken To Address Them

Office of Refugee Resettlement Ensured That Selected Care Providers Were Prepared to Respond to the COVID-19 Pandemic

National Snapshot of State Agency Approaches to Child Care During the COVID-19 Pandemic

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