OIG is focused on promoting the economy, efficiency, and effectiveness of Affordable Care Act (ACA) programs across HHS. We are conducting reviews of the health insurance marketplaces and related programs, as well as reviews of other health reform programs in Medicare, Medicaid, and the public health programs. Below is a consolidated list of reviews we have issued in these areas. It will be updated as new reviews are published.
| Report Title | Issue Date | Report Number |
|---|---|---|
| The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act | 02-28-2020 | (A-03-16-03001) |
| The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs | 02-07-2020 | (A-09-18-01000) |
| CMS Did Not Always Accurately Authorize Financial Assistance Payments to Qualified Health Plan Issuers in Accordance With Federal Requirements During the 2014 Benefit Year | 08-08-2018 | (A-02-15-02013) |
| New York Did Not Comply With Federal Grant Requirements for Allocating and Claiming Marketplace Contract Costs | 12-22-2017 | (A-02-15-02008) |
| CMS Did Not Provide Effective Oversight To Ensure That State Marketplaces Always Properly Determined Individuals' Eligibility for Qualified Health Plans and Insurance Affordability Programs | 09-25-2017 | (A-09-16-01002) |
| CMS Oversight Must Continue Because All Remaining Consumer Operated and Oriented Plans Were Not Profitable and May Not Be Viable and Sustainable | 08-25-2017 | (A-05-16-00027) |
| Briefing to The Honorable Gus Bilirakis, Subcommittee on Health, Committee on Energy and Commerce, House of Representatives | 05-08-2017 | (A-02-17-02001) |
| Data Inadequacies Undermine CMS's Oversight of the Inconsistency Resolution Process for the Federal Marketplace | 03-16-2017 | (OEI-01-14-00620) |
| Kentucky Misallocated Millions to Establishment Grants for a Health Insurance Marketplace | 02-02-2017 | (A-04-14-07050) |
| Colorado Did Not Correctly Expend Establishment Grant Funds for Establishing a Health Insurance Marketplace | 12-27-2016 | (A-07-14-02801) |
| The Minnesota Marketplace Misallocated Federal Funds and Claimed Unallowable Costs | 11-23-2016 | (A-05-14-00045) |
| New York Misallocated Costs to Establishment Grants for a Health Insurance Marketplace | 11-21-2016 | (A-02-14-02017) |
| Public Summary Report: New York Implemented Security Controls Over Its Health Insurance Exchange Web Site and Database but Could Improve Security Controls | 11-04-2016 | (A-02-15-03001) |
| Public Summary Report: Information Technology Control Weaknesses Found at the Minnesota Health Insurance Exchange | 09-26-2016 | (A-06-15-00035) |
| Vermont Did Not Properly Allocate Millions to Establishment Grants for a Health Insurance Marketplace | 09-23-2016 | (A-01-15-02500) |
| Conversions of Startup Loans Into Surplus Notes by Consumer Operated and Oriented Plans Were Allowable but Not Always Effective | 08-04-2016 | (A-05-16-00019) |
| Public Summary Report: Washington State Implemented Security Controls Over the Web Site and Database for Its Health Insurance Exchange but Could Improve Protection of Personally Identifiable Information | 06-01-2016 | (A-09-15-03005) |
| Not All of the Vermont Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 03-09-2016 | (A-01-14-02507) |
| HealthCare.gov: Case Study of CMS Management of the Federal Marketplace | 02-22-2016 | (OEI-06-14-00350) |
| Not All of the District of Columbia Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 02-22-2016 | (A-03-14-03301) |
| Nevada Misallocated Costs for Establishing a Health Insurance Marketplace to Its Establishment Grants | 02-17-2016 | (A-09-14-01007) |
| Not All of the Minnesota Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 02-12-2016 | (A-05-14-00043) |
| Public Summary Report: Connect for Health Colorado Generally Protected Personally Identifiable Information on Its Health Insurance Exchange Web Sites and Databases but Could Continue To Improve Information Security Controls | 02-10-2016 | (A-07-15-00454) |
| Not All of the Washington Marketplaces Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 01-19-2016 | (A-09-14-01006) |
| CMS Could Not Effectively Ensure That Advance Premium Tax Credit Payments Made Under the Affordable Care Act Were Only for Enrollees Who Paid Their Premiums | 12-31-2015 | (A-02-14-02025) |
| Not All of the Colorado Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 12-28-2015 | (A-07-14-03199) |
| The District of Columbia Claimed Allocated Costs to Its Establishment Grants in Accordance With Federal Requirements | 11-04-2015 | (A-03-14-03300) |
| The Kentucky Marketplace's Internal Controls Were Generally Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 10-14-2015 | (A-04-14-08036) |
| The Centers for Medicare and Medicaid Services' Implementation Of Security Controls Over the Multidimensional Insurance Data Analytics System Needs Improvement | 09-21-2015 | (A-06-14-00067) |
| Not All Internal Controls Implemented by the New York Marketplace Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 09-21-2015 | (A-02-14-02020) |
| CMS Did Not Identify All Federal Marketplace Contract Costs and Did Not Properly Validate the Amount To Withhold for Defect Resolution on the Principal Federal Marketplace Contrac | 09-18-2015 | (A-03-14-03002) |
| CMS Did Not Always Manage and Oversee Contractor Performance for the Federal Marketplace as Required by Federal Requirements and Contract Terms | 09-14-2015 | (A-03-14-03001) |
| Not All of the Federally Facilitated Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Properly Determined Eligible for Qualified Health Plans and Insurance Affordability Programs | 08-06-2015 | (A-09-14-01011) |
| Actual Enrollment and Profitability Was Lower Than Projections Made by the Consumer Operated and Oriented Plans and Might Affect Their Ability to Repay Loans Provided Under the Affordable Care Act | 07-29-2015 | (A-05-14-00055) |
| CMS's Internal Controls Did Not Effectively Ensure the Accuracy of Aggregate Financial Assistance Payments Made to Qualified Health Plan Issuers Under the Affordable Care Act | 06-16-2015 | (A-02-14-02006) |
| California Implemented Security Controls Over the Web Site and Databases for Its Health Insurance Exchange but Could Improve Protection of Personally Identifiable Information | 04-30-2015 | (A-09-14-03005) |
| Early Alert: Without Clearer Guidance, Marketplaces Might Use Federal Funding Assistance for Operational Costs When Prohibited by Law | 04-27-2015 | (A-01-14-02509) |
| Review of the Accounting Structure Used for the Administration of Premium Tax Credits | 03-31-2015 | (OEI-06-14-00590) |
| Maryland Misallocated Millions to Establishment Grants for a Health Insurance Marketplace | 03-26-2015 | (A-01-14-02503) |
| Federal Marketplace: Inadequacies in Contract Planning and Procurement | 01-20-2015 | (OEI-03-14-00230) |
| Health Insurance Marketplaces Generally Protected Personally Identifiable Information but Could Improve Certain Information Security Controls | 09-22-2014 | (A-18-14-30011) |
| An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace | 08-26-2014 | (OEI-03-14-00231) |
| Marketplaces Faced Early Challenges Resolving Inconsistencies With Applicant Data | 07-02-2014 | (OEI-01-14-00180) |
| Not All Internal Controls Implemented by the Federal, California, and Connecticut Marketplaces Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements | 06-30-2014 | (A-09-14-01000) |
| Observations Noted During the OIG Review of CMS's Implementation of the Health Insurance Exchange-Data Services Hub | 08-02-2013 | (A-18-13-30070) |
| The Centers for Medicare & Medicaid Services Awarded Consumer Operated and Oriented Plan Program Loans in Accordance With Federal Requirements, and Continued Oversight Is Needed | 07-30-2013 | (A-05-12-00043) |
| Early Implementation of the Consumer Operated and Oriented Plan Loan Program | 06-16-2013 | (OEI-01-12-00290) |
| Report Title | Issue Date | Report Number |
|---|---|---|
| Corporaci�n Salud Asegurada por Nuestra Organizaci�n Solidaria, Inc., a Health Resources and Services Administration Grantee, Generally Complied With Federal Grant Requirements | 11-29-2018 | (A-02-17-02004) |
| Pennsylvania Generally Complied With Maternal, Infant, and Early Childhood Home Visiting Program Requirements | 10-10-2018 | (A-03-15-03300) |
| Illinois Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements | 07-24-2018 | (A-05-16-00066) |
| Henry J. Austin Health Center, Inc., a Health Resources and Services Administration Grantee, Did Not Comply With Federal Grant Requirements | 02-01-2018 | (A-02-17-02002) |
| Indiana Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements | 12-22-2017 | (A-05-16-00056) |
| Wisconsin Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements | 09-11-2017 | (A-05-15-00049) |
| CMS Validated Hospital Inpatient Quality Reporting Program Data, But Should Use Additional Tools to Identify Gaming | 05-01-2017 | (OEI-01-15-00320) |
| Housing Works, Inc., Did Not Always Comply With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant | 12-08-2016 | (A-02-15-02001) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2016 | 06-29-2016 | (OEI-05-16-00090) |
| State Efforts to Exclude 340B Drugs from Medicaid Managed Care Rebates | 06-07-2016 | (OEI-05-14-00430) |
| Observations From Our Review of CMS's Administration of the First Performance Year of the Pioneer Accountable Care Organization Payment Model | 05-31-2016 | (A-01-13-00509) |
| Medicaid Enhanced Provider Enrollment Screenings Have Not Been Fully Implemented | 05-20-2016 | (OEI-05-13-00520) |
| Medicaid: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure | 05-20-2016 | (OEI-04-11-00590) |
| Medicare Vulnerabilities Related to Provider Enrollment and Ownership Disclosure | 05-20-2016 | (OEI-04-11-00591) |
| Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results | 04-27-2016 | (OEI-03-13-00050) |
| Inconsistencies in State Implementation of Correct Coding Edits May Allow Improper Medicaid Payments | 04-15-2016 | (OEI-09-14-00440) |
| The Ohio Association of Foodbanks Generally Complied With the Navigator Requirements Related to the Affordable Care Act | 04-05-2016 | (A-05-15-00013) |
| HPM Foundation, Inc., Did Not Always Comply With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant | 02-05-2016 | (A-02-14-02022) |
| Hidalgo Medical Services Did Not Comply With All Federal Requirements Related to Its Capital Development Grant | 01-25-2016 | (A-06-14-00056) |
| National Background Check Program for Long-Term-Care Employees: Interim Report | 01-19-2016 | (OEI-07-10-00420) |
| North Carolina Department of Health and Human Services Did Not Always Claim Costs Under CDC Prevention and Public Health Fund Awards in Accordance with Federal Requirements | 01-14-2016 | (A-04-14-04028) |
| Arkansas Complied With the Requirements of the Affordable Care Act in Its Review of Cases of Credible Allegations of Medicaid Fraud | 09-21-2015 | (A-06-15-00026) |
| States' Collection of Rebates for Drugs Paid Through Medicaid Managed Care Organizations Has Improved | 09-16-2015 | (OEI-05-14-00431) |
| Washington State Did Not Suspend Medicaid Payments to Some Providers With Credible Allegations of Fraud in Accordance With the Affordable Care Act | 08-31-2015 | (A-09-14-02018) |
| Providers Did Not Always Reconcile Patient Records With Credit Balances and Report and Return the Associated Medicaid Overpayments to State Agencies | 08-26-2015 | (A-04-14-04029) |
| Community of Hope Generally Complied With the Requirements of a Capital Development Grant Funded Under the Affordable Care Act | 08-18-2015 | (A-03-14-03304) |
| Providers Terminated from One State Medicaid Program Continued Participating in Other States | 08-04-2015 | (OEI-06-12-00030) |
| Not All States Reported Medicaid Managed Care Encounter Data as Required | 07-02-2015 | (OEI-07-13-00120) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2015 | 06-30-2015 | (OEI-05-15-00120) |
| East Harlem Council for Human Services, Inc., Complied With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant | 05-21-2015 | (A-02-14-02021) |
| Chase Brexton Health Care Complied With the Requirements of a Community Health Center Grant Funded Under the Affordable Care Act | 05-21-2015 | (A-03-14-03303) |
| Medicaid Rebates for Brand-Name Drugs Exceeded Part D Rebates by a Substantial Margin | 04-21-2015 | (OEI-03-13-00650) |
| Lone Star Circle of Care Complied With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant | 04-07-2015 | (A-06-14-00058) |
| Ohio Did Not Always Comply With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud | 03-09-2015 | (A-05-14-00008) |
| Medicare Hospices Have Financial Incentives To Provide Care in Assisted Living Facilities | 01-13-2015 | (OEI-02-14-00070) |
| States' Collection of Offset and Supplemental Medicaid Rebates | 12-12-2014 | (OEI-03-12-00520) |
| Minnesota Complied With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud | 11-21-2014 | (A-05-14-00009) |
| Pennsylvania Complied With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud | 06-25-2014 | (A-03-14-00202) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2014 | 06-11-2014 | (OEI-05-14-00170) |
| Annual Fee on Branded Prescription Drug Companies Under the Affordable Care Act | 04-19-2014 | (OEI-03-12-00560) |
| Kentucky Did Not Pay Some Line Items on Medicaid Claims in Accordance With Its Medicaid National Correct Coding Initiative Methodologies | 02-05-2014 | (A-04-13-06166) |
| Review of Jersey City Early Retiree Reinsurance Program | 01-10-2014 | (A-05-12-00039) |
| Georgia Did Not Pay Some Line Items on Medicaid Claims in Accordance With Its Medicaid National Correct Coding Initiative Methodologies | 12-04-2013 | A-04-12-06159 |
| Arkansas Properly Reported the Affordable Care Act Portion of Medicaid Drug Rebates | 10-21-2013 | (A-06-13-00034) |
| Medicaid Drug Pricing in State Maximum Allowable Cost Programs | 08-29-2013 | (OEI-03-11-00640) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2013 | 06-03-2013 | (OEI-05-13-00090) |
| Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder | 04-01-2013 | (OEI-03-11-00560) |
| The UAW Retiree Medical Benefits Trust Properly Claimed Early Retiree Reinsurance Program Reimbursements | 12-19-2012 | (A-05-11-00108) |
| The Chicago Regional Council of Carpenters Welfare Fund Properly Claimed Early Retiree Reinsurance Program Reimbursements | 12-19-2012 | (A-05-11-00109) |
| Criminal Convictions for Nurse Aides With Substantiated Findings of Abuse, Neglect, and Misappropriation | 10-05-2012 | (OEI-07-10-00422) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2012 | 06-07-2012 | (OEI-05-12-00060) |
| Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles | 05-26-2011 | (OEI-05-10-00390) |
| Centers for Disease Control and Prevention Did Not Meet Program Expansion Supplement Requirements for Awarding One Affordable Care Act Grant | 04-13-2012 | (A-04-11-01003) |
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