Spring Semiannual Report to Congress

What's New

June 6, 2025

HHS’s Grant Payment System Lacked Effective Internal Controls To Prevent $7.8 Million in Fraud, and HHS Has Begun Taking Corrective Actions To Reduce Fraud Risk A-18-24-03700

June 5, 2025

FDA Food Safety Inspections of Domestic Food Facilities OEI-02-23-00300

Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health and Life Insurance Company (Contract H1608) Submitted to CMS A-02-22-01020

June 3, 2025

Indian Health Service's Controls Over Sanitation Facilities Construction Program Projects Funded Under the Infrastructure Investment and Jobs Act Could Be Improved

Enforcement Actions

June 5, 2025; U.S. Department of Justice

Louisiana Man Pleads Guilty to $3.8 Million Durable Medical Equipment Fraud Scheme

June 4, 2025; U.S. Attorney's Office, District of Maryland

Rosedale Woman Pleads Guilty to Conspiracy to Distribute Controlled Substances and Money Laundering

June 3, 2025; U.S. Department of Justice

CEO of Health Care Software Company Convicted of $1B Fraud Conspiracy

June 3, 2025; U.S. Attorney's Office, Eastern District of Wisconsin

Florida Man Sentenced to 22 Months’ Imprisonment for Conspiracy to Pay and Receive Healthcare Kickbacks

What's Trending

1. Medicare Payments for Evaluation and Management Services Provided on the Same Day as Eye Injections Were at Risk for Noncompliance With Medicare Requirements
2. 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 2024
3. Potential Cost Savings in HHS Programs: Legislative Actions
4. Compliance Programs for Physicians
5. Potential Cost Savings: HHS Actions