Potential Cost Savings: HHS Actions

Based on the recovery of payments and HHS program improvements.

These potential cost savings are based on a select subset of OIG reports that identified significant misspent funds or cost saving improvements that could be made to HHS programs.

Reports

Select Reports with Misspent Funds

• The Centers for Medicare & Medicaid Services Had Not Recovered More Than a Billion Dollars in Medicaid Overpayments Identified by OIG Audits
• 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
• Tennessee Medicaid Claimed Hundreds of Millions of Federal Funds for Certified Public Expenditures That Were Not in Compliance With Federal Requirements
• Pennsylvania Improperly Claimed $551 Million in Medicaid Funds for Its School-Based Program
• Heluna Health May Not Have Used California’s CDC COVID-19 Funds in Accordance With Award Requirements
• New York Improperly Claimed $439 Million In Medicaid Funds for Its School-Based Health Services Based on Certified Public Expenditures
• HHS's Oversight of Automatic Provider Relief Fund Payments Was Generally Effective but Improvements Could Be Made
• Florida Did Not Refund $106 Million Federal Share of Medicaid Managed Care Rebates It Received for Calendar Years 2015 Through 2020
• New York Claimed $196 Million, Over 72 Percent of the Audited Amount, in Federal Reimbursement for NEMT Payments to New York City Transportation Providers That Did Not Meet or May Not Have Met Medicaid Requirements
• States Could Do More To Prevent Terminated Providers From Serving Medicaid Beneficiaries

Select Reports with Potential Savings

• Medicare Advantage: Questionable Use of Health Risk Assessments Continues To Drive Up Payments to Plans by Billions
• Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns
• Medicare and Beneficiaries Paid Substantially More to Provider-Based Facilities in Eight Selected States in Calendar Years 2010 Through 2017 Than They Paid to Freestanding Facilities in the Same States for the Same Type of Services
• Medicare Allowable Amounts for Certain Orthotic Devices Are Not Comparable With Payments Made by Select Non-Medicare Payers
• Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit
• Medicare Could Have Saved Approximately $993 Million in 2017 and 2018 if It Had Implemented an Inpatient Rehabilitation Facility Transfer Payment Policy for Early Discharges to Home Health Agencies
• Medicare Could Have Saved Up To $128 Million Over 5 Years if CMS Had Implemented Controls To Address Duplicate Payments for Services Provided to Individuals With Medicare and Veterans Health Administration Benefits
• Medicare Could Save Millions if It Implements an Expanded Hospital Transfer Payment Policy for Discharges to Postacute Care
• Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States
• Medicare and Beneficiaries Could Save Billions If CMS Reduces Hospital Outpatient Department Payment Rates for Ambulatory Surgical Center-Approved Procedures to Ambulatory Surgical Center Payment Rates
• Medicare Could Save Billions With Comparable Access for Enrollees if Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
• Medicare Payments of $6.6 Billion to Nonhospice Providers Over 10 Years for Items and Services Provided to Hospice Beneficiaries Suggest the Need for Increased Oversight
• Medicare Part D Paid Millions for Drugs for Which Payment Was Available Under the Medicare Part A Skilled Nursing Facility Benefit
• Medicare Improperly Paid Acute-Care Hospitals an Estimated $190 Million Over 5 Years for Outpatient Services Provided to Hospice Enrollees
• HRSA Made Some Potential Overpayments to Providers Under the Phase 2 General Distribution of the Provider Relief Fund Program
• Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2022 Average Sales Prices
• Biosimilars Have Lowered Costs for Medicare Part B and Enrollees, but Opportunities for Substantial Spending Reductions Still Exist
• Reducing Medicare's Payment Rates for Intermittent Urinary Catheters Can Save the Program and Beneficiaries Millions of Dollars Each Year
• Trend Toward More Expensive Inpatient Hospital Stays in Medicare Emerged Before COVID-19 and Warrants Further Scrutiny
• Medicare Laboratory Test Expenditures Increased in 2018, Despite New Rate Reductions
• Vulnerabilities Remain Under Medicare's 2-Midnight Hospital Policy
• The Medicare Payment System for Skilled Nursing Facilities Needs To Be Reevaluated
• Least Costly Alternative Policies: Impact on Prostate Cancer Drugs Covered Under Medicare Part B
• Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018
• Loophole in Drug Payment Rule Continues To Cost Medicare and Beneficiaries Hundreds of Millions of Dollars

Last updated May 21, 2025