OIG’s Semiannual Report to Congress Emphasizes Ongoing Focus on Enforcement

The Office of the Inspector General (OIG) recently released its Semiannual Report to Congress summarizing its work between April 1 and September 30, 2018. During the 2018 fiscal year, OIG issued 163 audit reports and 45 evaluations that led to 578 new recommendations to various agencies of the Department of Health and Human Services (HHS). The following are some of the major accomplishments that were covered in this Semiannual Report.

Ongoing Oversight of HHS Programs

For the 2018 fiscal year, the OIG reports $521 million in audit recoveries as well as $2 billion in questioned costs through its audit activities. Additionally, the OIG reports that $823 million in funds were put to better use as a result of its oversight and recommendations. For example, OIG previously recommended to the Centers for Medicare and Medicaid Services (CMS) that CMS implement periodic reviews of claims for replacement positive airway pressure device supplies. OIG estimated this could have saved Medicare an estimated $631 million over the course of two years.

Fighting Fraud in HHS Programs

OIG remains focused on fighting fraud that occurs within HHS programs, especially Medicare and Medicaid. During the 2018 fiscal year, OIG reports that 764 criminal actions were initiated against individuals and entities that committed crimes against programs offered by HHS. In addition, 2,712 individuals were excluded from Federal healthcare programs, and 813 civil actions were initiated against entities or individuals. OIG estimates that its investigative recoveries related to criminal and civil fraud cases will amount to $2.91 billion.

Closer Scrutiny of the Medicare Hospice Benefit

OIG has recently identified significant vulnerabilities in the Medicare hospice program. In July 2018, OIG released a report identifying key vulnerabilities and making 15 substantive recommendations to CMS for protecting beneficiaries and improving the program. OIG also noted its ongoing enforcement activities against hospice providers; numerous providers around the country were the target of civil and criminal fraud investigations in 2018. One large national hospice provider, for example, agreed to pay $8.5 million to settle allegations that it had improperly submitted claims to Medicare for beneficiaries who were ineligible for hospice services.

Medicaid Program Integrity Efforts

OIG continues to work closely with CMS and state authorities regarding the integrity of the Medicaid program. In 2018, OIG issued numerous reports (along with recommendations to the appropriate agencies) regarding Medicaid payment integrity issues. In one instance, OIG identified $180.6 million in unallowable Federal reimbursement claimed by California’s Medicaid program. OIG has also raised concerns regarding perceived vulnerabilities in Medicaid managed care programs.


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