Goodsurance

Policy & oversight

OIG: Conflicting Medicare Rules Allowed an Estimated 380 Million Dollars in Organ Payments Not Required by Federal Law

A federal audit completed September 1 found that CMS guidance permitted reimbursements to certified transplant centers for organs never implanted in Medicare patients, diverging from what federal statute requires.

By the Goodsurance editorial teamSeptember 6, 2026

The Office of Inspector General released audit report OAS-25-07-124 finding that Medicare paid an estimated 380 million dollars over a six-year period for organs acquired by certified transplant centers but never transplanted into Medicare enrollees. The OIG concluded the payments resulted from a conflict between CMS agency guidance and the governing federal statute.

Federal law, as the OIG interprets it, limits Medicare reimbursement for organ acquisition to cases where the organ is actually transplanted into a Medicare-covered beneficiary. CMS guidance, however, allowed transplant centers to bill Medicare for any usable organ they obtained, whether or not it went to a Medicare patient. That gap created conditions in which Medicare bore costs for organs that ultimately served patients covered by other payers.

Medicare paid an estimated 380 million dollars for organs not implanted in Medicare patients, a federal audit found.

The OIG estimated the program-wide cost of the discrepancy at roughly 380 million dollars across the audit window. The watchdog recommended CMS revise its guidance to match statutory requirements and consider steps to address past overpayments.

Transplant centers and organ procurement organizations receive Medicare reimbursement for organ acquisition costs because those costs are not captured in standard hospital billing. The audit does not allege wrongdoing by any transplant center; the OIG attributed the problem to contradictory federal guidance, not provider misconduct.

CMS did not immediately respond publicly to the report, which was published by the OIG on September 1, 2026.

In plain words

A government watchdog reviewed how Medicare pays transplant hospitals for organs. It found that Medicare paid about 380 million dollars over six years for organs that went to patients not covered by Medicare. Federal law says Medicare should only pay for organs used in Medicare patients. But CMS instructions to hospitals allowed broader payments. The watchdog says CMS should update its instructions to match the law.

Understand the basics first

Source: OIG
Read at the source →

More news

Other stories on what is moving in Medicare.

Policy & oversight

OIG: Medicare Paid an Estimated 15.2 Million Dollars for Incorrectly Coded Sacroiliac Joint Injections

A federal audit found that roughly 72 percent of sampled Medicare claims for the procedure used the wrong billing category, with physicians repeatedly coding diagnostic injections as the higher-paid therapeutic type.

October 22, 2026

Policy & oversight

KFF Poll: Two-Thirds of U.S. Adults Back Medicare-for-All as Health Care Costs Top Midterm Voter Concerns

A KFF health tracking poll finds support for a government-run national health plan has reached its highest recorded level, and six in ten voters say they worry about affording health care. The results land as Medicare beneficiaries are comparing 2027 plan options during open enrollment.

October 21, 2026

Policy & oversight

Maryland Lab Owner Convicted of 18.7 Million Dollar Medicare Fraud That Used Nursing Home COVID Testing as Cover

A federal jury found Patrick Britton-Harr guilty of billing Medicare for respiratory tests that were never ordered, never performed, and in some cases attributed to residents who had already died.

October 21, 2026

Policy & oversight

Maryland Receives 16.4 Million Dollars in Federal Rural Health Funds to Recruit and Train Healthcare Workers

A new CMS announcement directs funding from the 50-billion-dollar Rural Health Transformation Program toward provider shortages in rural Maryland, covering apprenticeships, career pipelines, and retention incentives.

October 19, 2026

Policy & oversight

Ohio Gets 92 Million Dollars to Build Rural Hospital Networks, Improve Maternal Care, and Upgrade 22 Facilities

The Centers for Medicare and Medicaid Services announced the funds October 16, dividing them across coordinated care networks, maternal health, and one-time equipment purchases.

October 17, 2026

Policy & oversight

DOJ and HHS-OIG Unify Health Care Fraud Reporting Into a Single Disclosure

Health care companies seeking to voluntarily report potential criminal fraud involving Medicare or Medicaid now need to file with only one federal agency instead of two.

October 17, 2026