Persius/hicric huggingface dataset:
OIG NEWS 
Office of Inspector General 
330 Independence Ave., SW 
Washington, D. C. 20201 
(202) 619-1343 
For Immediate Release 
December 11, 2002 
OIG SAVES TAXPAYERS 
RECORD $21 BILLION 
The Office of Inspector General of the Department of Health and Human Services (HHS) saved

American taxpayers a record $21 billion in Fiscal Year 2002, Inspector General Janet Rehnquist 

announced today.

The Inspector General said the savings were achieved through an intensive and continuing

crackdown on waste, fraud and abuse in Medicare and over 300 other HHS programs for which

the Office of Inspector General (OIG) has oversight responsibility. 

At a time of growing concern about the status of the economy and corporate Americas

integrity, taxpayers can be confident in the determination of my office to protect their tax dollars

against waste, fraud, abuse, and mismanagement, the Inspector General said. Through our

audits, investigations and evaluations we will continue to promote economy, efficiency, and

effectiveness in all of the departments programs and operationstaxpayers deserve nothing

less. 

The $21 billion saved is $3 billion more than the savings reported for FY 2001 and $13.5 billion

more than what the OIG saved taxpayers in FY 1997, when Congress greatly increased the

authorities and financial resources of federal agencies to combat health care fraud.

The savings consist of $1.49 billion in investigative receivables, $426 million in audit

disallowances, and $19.9 billion in the implementation of OIG recommendations to achieve

Medicare efficiencies through reduced costs and improved operations. The savings, for the most

part, were independently scored by the Congressional Budget Office.
 Inspector General Rehnquist said that in FY 2002 the agency performed or oversaw 2,372 audits, 
conducted 70 evaluations of department programs, and opened 1,654 new civil and criminal 
cases, bringing to more than 2,700 the number of active OIG investigations. Additionally, the 
OIG excluded 3,448 individuals and entities from participation in Medicare, Medicaid and other 
federally sponsored health care programs, and its enforcement efforts resulted in 517 criminal 
convictions and 236 successful civil actions. 
In other activities, the OIGs crackdown on child support defaulters resulted in 152 convictions 
and court-ordered criminal restitution of over $7 million during the fiscal year. In a national 
operation, the OIG and HHS Office of Child Support Enforcement organized and led the 
departments largest ever dragnet for delinquent parents with substantial arrearages who had fled 
across state lines to evade their financial obligations. The coordinated sweep by OIG, U.S. 
Marshals Service, and state and local police resulted in the arrests of 70 of the nations most 
wanted deadbeat parents. 
Details of some of the activities are contained in the U.S. Department of Health and Human 
Services Office of Inspector General Semiannual Report to the Congress. It is available on the 
Internet at www.oig.hhs.gov/publications/semiannual.html 
###
I.  Introduction 
Purpose and Objectives 
In the period January through May 1985, a national program 
inspection on Medicare coverage of chiropractic services 
was conducted by the Region V (Chicago) Office of Analysis 
and Inspections, Office of the Inspector General, 
Department of Health and Human Services. 
This study was done in response to growing concerns 
regarding:  the rapidly rising cost of chiropractic care 
under Medicare Part B; the possible implications of 
previously conducted OIG targeted investigations of 
chiropractors; an emerging perception that current Medicare 
legislation and regulations may not be administered in such 
a way as to provide intended limits on coverage; and a 
perception by chiropractors and others that the benefit 
does not adequately cover or reflect current patterns of 
practice. 
The inspection had four general objectives: 
o  To develop an understanding of chiropractic as a 
profession as seen by its practitioners, schools and 
associations, as well as representatives of mainstream 
medicine. 
o  To explore with the chiropractic community how current 
Medicare legislation and regulations affect them and 
their patients, and in particular to discuss with them 
how they evaluate the x-ray requirement and handle 
billing. 
o  To gather and analyze data on patterns of chiropractic 
utilization and expenditures under Medicare, Part B. 
o  To examine how Medicare Part B carriers process 
chiropractic claims and to determine the effects of 
their screens and reviews. 
Methods 
In order to achieve these objectives, the inspection had 
three major segments:
'''Ylr," 
".t 
DEPARTMENT OF HEALTH &. HUMAN SERVICES  Office of Inspector General 
MemorandulT 
Date SE I 8 199 

Richard P. Kusserow 
From Inpector General 

" OIG Management Adviory Report: "Medicae Prepayment Review - Pre  ayment
U Ject

Utiltion Savigs," OEI-07-89-01681

Gail R. Wilensky, Ph.

Admtrator 
Health Cae Financing Admtration 
The Offce of Inspector General (OIG) recently conducted a program inpection 

the prepayment review process for Medicae Par B clai. One area of focu

during the revew was the verication of savigs claied to have been achieved by 
caers 
the  as a resultt orf  conducting medica reviews. The inpection was 
clai 
determe if an audit  exited for those  resultig in prepayment medical 
review savigs and whether the savigs were correctly reported in the caers 
quarerly Medica Review Report for Fisca Year (F 1989. Th management 
durg 
advisory report conveys the fiding identifed  the inpection. 
BACKGROUND 
In December 1989; the Health Care Financing Admtration (HCF A) required 
caers 
to establih an audit trai for al servces denied or reduced as a result of 
medica review. Ths requirement followed a study of prepayment medica review 
screens by HCFA in November 1988. Caer savigs due to prepayment controls 
for front end medica necessity denials (Category 1) and HCFA mandated and caer 
intiated screens (Category n) are maintaied and reported to HCFA on the 
quarerly Medical Review Report as provided for in the Medicae Carers Manual 
Section 7529. The HCF A uses the savigs data from the quarerly Medical Review 
Report and the cost benefit ratios resulting from review activities to identif effective 
prepayment screens and as a source for contractor evaluations. 
METODOLOGY 
We conducted on-site reviews at seven caers in early 1990. We asked caers 

provide a liting of all the Category I and Category n claims used to prepare the

Medica Review Report for the fourth quarer FY 1989. One carrer provided a

claims liting for the fist quarter FY 1990 instead, because data for the FY 1989

period was not available at the time of our review. A random sample of 30 claims

were selected for review from each carrer s listing. The savings resulting from the

sampled claims were then tracked to the Medical Review Report.  Page 2 - Gail R. 
Wilensky, Ph. 
FIING 
Ca 
meal rev 
have establihe relible system for reportg  savi&f. 
Based on the carrers' control sheets , the review team was able to verify the accuracy 
of the carrers' reported savigs for 192 of 195 claims. We limited our sample to 
claims, instead of 30 claims at one carrer, because the carrer 
could not provide a 
universe of claims. Twenty-nine of the 195 sampled claims had insuffcient 
information in the control sheets to 
readily establish the validity of the savings. 
However, upon further investigation, these claims proved to be valid. 
Should there be any questions, please have your staff contact Barr Steeley at 
FTS 646-3138.
November 13, 2023 
TO:  Chiquita Brooks-LaSure 
Administrator 
Centers for Medicare & Medicaid Services 
FROM:   Ann Maxwell 
Deputy Inspector General 
 for Evaluation and Inspections  
SUBJECT:   Comparison of Average  Sales Prices and Average Manufacturer Prices:  Results  
for the Second Quarter of 2023, OEI-03-24-00040  
This memorandum summarizes the results of the Office of  Inspector Generals (OIGs)  
comparison of average sales prices (ASPs) and average manufacturer prices  (AMPs) for the  
second quarter of 2023.  By law, OIG must notify the Secretary of Health and Human Services if  
the ASP for a particular  drug exceeds the drugs  AMP by 5 percent or more.  If that threshold is  
met, the Secretary may disregard the drugs ASP when setting the reimbursement amount and 
substitute the lesser of either the widely available  market price or 103 percent of the AMP.   
In April 2013, the Centers for Medicare & Medicaid Services (CMS) began making price  
substitutions  in accordance with the November 2012 final rule specifying the circumstances  
under which AMP-based price substitutions occur.  Pursuant to the rule, CMS substitutes  
103 percent of the AMP  for the ASP-based reimbursement amount when OIG identifies a drug 
code that exceeds the 5-percent threshold for two consecutive quarters or three of the previous  
four quarters.  CMS lowers reimbursement amounts only when ASP and AMP comparisons are  
based on the same set of  drug products (i.e., based on complete AMP data).  To prevent CMS  
from inadvertently raising the Medicare reimbursement amount, a price substitution is not  
implemented if the substituted amount would exceed the ASP-based payment amount for the  
quarter in which the price substitution would take effect.  In addition, price substitutions are not  
implemented for drugs that the Food and Drug Administration (FDA) identifies as being in short  
supply.  
OIG found that in the second quarter of 2023, eight drug codes met CMSs price-substitution 
criteria by exceeding the  5-percent threshold for two consecutive quarters  or three of the  
previous four quarters, on the basis of complete AMP data.  OIG found four additional drug 
codes that, on the basis of complete AMP data, exceeded the 5-percent threshold.  However, at  
the time of our analysis, FDA identified these four drugs as being in short  supply.  Another six  Page  2Chiquita  Brooks-LaSure  
drug  codes had  ASPs  that exceeded  the  AMPs  by  at  least  5  percent  in  the  second  quarter  of  2023,  
on  the  basis of  complete  AMP  data,  but  these  six  drug  codes  did  not  meet  other  CMS  
price-substitution  criteria.     
 
We  will  provide  you  with  the  results  of  our  pricing  comparison  for  the  second  quarter  of  2023,  as  
well  as  the  results  for  the  three  previous  quarters.   This  information  will  be  transmitted  via  our  
secure  file  transfer  system.
TO:  Chiquita Brooks-LaSure 
  Administrator 
  Centers for Medicare & Medicaid Services 
 
 
FROM:  Ann Maxwell 
Deputy Inspector General 
   for Evaluation and Inspections 
 
 
SUBJECT:  Comparison of Average Sales Prices and Average Manufacturer Prices: Results 
for the First Quarter of 2023, OEI-03-23-00100 
 
 
This memorandum summarizes the results of the Office of Inspector Generals (OIGs) 
comparison of average sales prices (ASPs) and average manufacturer prices (AMPs) for the 
first quarter of 2023.  By law, OIG must notify the Secretary of Health and Human Services if 
the ASP for a particular drug exceeds the drugs AMP by 5 percent or more.  If that threshold is 
met, the Secretary may disregard the drugs ASP when setting the reimbursement amount and 
substitute the lesser of either the widely available market price or 103 percent of the AMP.   
 
In April 2013, the Centers for Medicare & Medicaid Services (CMS) began making price 
substitutions in accordance with the November 2012 final rule specifying the circumstances 
under which AMP-based price substitutions occur.  Pursuant to the rule, CMS substitutes 
103 percent of the AMP for the ASP-based reimbursement amount when OIG identifies a drug 
code that exceeds the 5-percent threshold for two consecutive quarters or three of the previous 
four quarters.  CMS lowers reimbursement amounts only when ASP and AMP comparisons are 
based on the same set of drug products (i.e., based on complete AMP data).  To prevent CMS 
from inadvertently raising the Medicare reimbursement amount, a price substitution is not 
implemented if the substituted amount would exceed the ASP-based payment amount for the 
quarter in which the price substitution would take effect.  In addition, price substitutions are not 
implemented for drugs that the Food and Drug Administration (FDA) identifies as being in short 
supply.  
 
OIG found that in the first quarter of 2023, 14 drug codes met CMSs price-substitution criteria 
by exceeding the 5-percent threshold for 2 consecutive quarters or 3 of the previous 4 quarters, 
on the basis of complete AMP data.  OIG found four additional drug codes that, on the basis of 
complete AMP data, exceeded the 5-percent threshold.  However, at the time of our analysis, 
FDA identified these four drugs as being in short supply.  Another nine drug codes had ASPs  Page 2Chiquita Brooks-LaSure 
that exceeded the AMPs by at least 5 percent in the first quarter of 2023, on the basis of complete 
AMP data, but these nine drug codes did not meet other CMS price-substitution criteria.    
 
We will provide you with the results of our pricing comparison for the first quarter of 2023, as 
well as the results for the three previous quarters.  This information will be transmitted via our 
secure file transfer system.
May 11, 2023
TO:  Chiquita Brooks-LaSure 
Administrator 
Centers for Medicare & Medicaid Services 
ANN  Digitally signed by ANN
FROM:  Ann Maxwell 
MAXWELL 
Deputy Inspector General  MAXWELL Date: 2023.05.11
   for Evaluation and Inspections  14:25:11 -04'00' 
SUBJECT:  Comparison of Average Sales Prices and Average Manufacturer Prices: Results 
for the Fourth Quarter of 2022, OEI-03-23-00090 
This memorandum summarizes the results of the Office of Inspector Generals (OIGs) 
comparison of average sales prices (ASPs) and average manufacturer prices (AMPs) for the 
fourth quarter of 2022.  By law, OIG must notify the Secretary of Health and Human Services if 
the ASP for a particular drug exceeds the drugs AMP by 5 percent or more.  If that threshold is 
met, the Secretary may disregard the drugs ASP when setting the reimbursement amount and 
substitute the lesser of either the widely available market price or 103 percent of the AMP.  
In April 2013, the Centers for Medicare & Medicaid Services (CMS) began making price 
substitutions in accordance with the November 2012 final rule specifying the circumstances 
under which AMP-based price substitutions occur.  Pursuant to the rule, CMS substitutes 
103 percent of the AMP for the ASP-based reimbursement amount when OIG identifies a drug 
code that exceeds the 5-percent threshold for two consecutive quarters or three of the previous 
four quarters.  CMS lowers reimbursement amounts only when ASP and AMP comparisons are 
based on the same set of drug products (i.e., based on complete AMP data).  To prevent CMS 
from inadvertently raising the Medicare reimbursement amount, a price substitution is not 
implemented if the substituted amount would exceed the ASP-based payment amount for the 
quarter in which the price substitution would take effect.  In addition, price substitutions are not 
implemented for drugs that the Food and Drug Administration (FDA) identifies as being in short 
supply. 
OIG found that in the fourth quarter of 2022, 16 drug codes met CMSs price-substitution criteria 
by exceeding the 5-percent threshold for 2 consecutive quarters or 3 of the previous 4 quarters, 
on the basis of complete AMP data. OIG found seven additional drug codes that, on the basis of 
complete AMP data, exceeded the 5-percent threshold.  However, at the time of our analysis, 
FDA identified these seven drugs as being in short supply. Another nine drug codes had ASPs  Page 2Chiquita Brooks-LaSure 
that exceeded the AMPs by at least 5 percent in the fourth quarter of 2022, on the basis of 
complete AMP data, but these nine drug codes did not meet other CMS price-substitution 
criteria. 
 
We will provide you with the results of our pricing comparison for the fourth quarter of 2022, as 
well as the results for the three previous quarters.  This information will be transmitted via our 
secure file transfer system.
February 10, 2023 
TO:  Chiquita Brooks-LaSure 
Administrator 
Centers for Medicare & Medicaid Services 
ANN  Digitally signed by
FROM:  Ann Maxwell 
ANN MAXWELL
Deputy Inspector General 
MAXWELL  Date: 2023.02.10
   for Evaluation and Inspections 
12:35:18 -05'00' 
SUBJECT:  Comparison of Average Sales Prices and Average Manufacturer Prices: Results 
for the Third Quarter of 2022, OEI-03-23-00080 
This memorandum summarizes the results of the Office of Inspector Generals (OIGs) 
comparison of average sales prices (ASPs) and average manufacturer prices (AMPs) for the 
third quarter of 2022.  By law, OIG must notify the Secretary of Health and Human Services if 
the ASP for a particular drug exceeds the drugs AMP by 5 percent or more.  If that threshold is 
met, the Secretary may disregard the drugs ASP when setting the reimbursement amount and 
substitute the lesser of either the widely available market price or 103 percent of the AMP.  
In April 2013, the Centers for Medicare & Medicaid Services (CMS) began making price 
substitutions in accordance with the November 2012 final rule specifying the circumstances 
under which AMP-based price substitutions occur.  Pursuant to the rule, CMS substitutes 
103 percent of the AMP for the ASP-based reimbursement amount when OIG identifies a drug 
code that exceeds the 5-percent threshold for two consecutive quarters or three of the previous 
four quarters.  CMS lowers reimbursement amounts only when ASP and AMP comparisons are 
based on the same set of drug products (i.e., based on complete AMP data).  To prevent CMS 
from inadvertently raising the Medicare reimbursement amount, a price substitution is not 
implemented if the substituted amount would exceed the ASP-based payment amount for the 
quarter in which the price substitution would take effect.  In addition, price substitutions are not 
implemented for drugs that the Food and Drug Administration (FDA) identifies as being in short 
supply. 
OIG found that in the third quarter of 2022, 15 drug codes met CMSs price-substitution criteria 
by exceeding the 5-percent threshold for 2 consecutive quarters or 3 of the previous 4 quarters, 
on the basis of complete AMP data. OIG found eight additional drug codes that, on the basis of 
complete AMP data, exceeded the 5-percent threshold.  However, at the time of our analysis, 
FDA identified these drugs as being in short supply. Another 18 drug codes had ASPs that  Page 2Chiquita Brooks-LaSure 
exceeded the AMPs by at least 5 percent in the third quarter of 2022, on the basis of complete 
AMP data, but these drug codes did not meet other CMS price-substitution criteria.    
 
We will provide you with the results of our pricing comparison for the third quarter of 2022, as 
well as the results for the three previous quarters.  This information will be transmitted via our 
secure file transfer system.
November 15, 2022 
TO:  Chiquita Brooks-LaSure 
Administrator 
Centers for Medicare & Medicaid Services 
ANN Digitally signed by 
FROM:  Ann Maxwell  ANN MAXWELL 
Deputy Inspector General MAXWELL Date: 2022.11.15 
   for Evaluation and Inspections  12:50:51 -05'00' 
SUBJECT:  Comparison of Average Sales Prices and Average Manufacturer Prices: Results 
for the Second Quarter of 2022, OEI-03-23-00070 
This memorandum summarizes the results of the Office of Inspector Generals (OIGs) 
comparison of average sales prices (ASPs) and average manufacturer prices (AMPs) for the 
second quarter of 2022.  By law, OIG must notify the Secretary of Health and Human Services if 
the ASP for a particular drug exceeds the drugs AMP by 5 percent or more.  If that threshold is 
met, the Secretary may disregard the drugs ASP when setting the reimbursement amount and 
substitute the lesser of either the widely available market price or 103 percent of the AMP.  
In April 2013, the Centers for Medicare & Medicaid Services (CMS) began making price 
substitutions in accordance with the November 2012 final rule specifying the circumstances 
under which AMP-based price substitutions occur.  Pursuant to the rule, CMS substitutes 
103 percent of the AMP for the ASP-based reimbursement amount when OIG identifies a drug 
code that exceeds the 5-percent threshold for two consecutive quarters or three of the previous 
four quarters.  CMS lowers reimbursement amounts only when ASP and AMP comparisons are 
based on the same set of drug products (i.e., based on complete AMP data).  To prevent CMS 
from inadvertently raising the Medicare reimbursement amount, a price substitution is not 
implemented if the substituted amount would exceed the ASP-based payment amount for the 
quarter in which the price substitution would take effect.  In addition, price substitutions are not 
implemented for drugs that the Food and Drug Administration (FDA) identifies as being in short 
supply. 
OIG found that in the second quarter of 2022, seven drug codes met CMSs price-substitution 
criteria by exceeding the 5-percent threshold for two consecutive quarters or three of the 
previous four quarters, on the basis of complete AMP data. OIG found nine additional drug 
codes that, on the basis of complete AMP data, exceeded the 5-percent threshold.  However, at 
the time of our analysis, FDA identified these drugs as being in short supply. Another 15 drug  Page 2Chiquita Brooks-LaSure 
codes had ASPs that exceeded the AMPs by at least 5 percent in the second quarter of 2022, on 
the basis of complete AMP data, but these drug codes did not meet other CMS price-substitution 
criteria. 
 
We will provide you with the results of our pricing comparison for the second quarter of 2022, as 
well as the results for the three previous quarters.  This information will be transmitted via our 
secure file transfer system.