Indoor fumigation of honey bees, Apis mellifera L., with formic acid to control varroa mites, Varroa destructor Anderson & Trueman, allows simultaneous fumigation of multiple colonies with little labor input and good efficacy. Several experiments were designed to test the efficacy of formic acid as a treatment for honey bee mites, Acarapis woodi (Rennie) (Acari: Tarsonemidae), and nosema disease, Nosema sp., indoors in winter. The objectives of this study were (1) to determine the efficacy of formic acid fumigation for honey bee mite control by using both the thoracic slice and live dissection methods and (2) to determine whether indoor fumigation can reliably prevent the buildup of nosema disease in overwintering honey bee colonies. Indoor winter fumigation of honey bee colonies with formic acid was effective in killing a high percentage of honey bee mites but did not significantly reduce the proportion of bees with infested tracheae over the duration of the experiments. Thus, the method used to determine the efficacy of the treatment affected the results. Under conditions of relatively low or decreasing levels of nosema, fumigation tended to suppress the mean abundance of nosema spores relative to the controls. In three separate fumigation experiments using a range of formic acid concentrations, there was no statistical difference between the buildup or maintenance of nosema spore mean abundance over the winter in bees from formic acid fumigated colonies compared with untreated controls. However, fumigation with formic acid during winter at a low concentration for extended periods significantly suppressed spore buildup of mixed populations of nosema (Nosema apis and Nosema ceranae) in 1 yr.