HHS OIG Publishes Semiannual Report to Congress Detailing Efforts to Combat Fraud and Abuse & $800 million in potential savings

The Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published its Spring 2019 Semiannual Report to Congress. The Report covers the period of October 1, 2018 through March 31, 2019, and identifies “significant problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs and operations” for that period.

During the reporting period, OIG focused its efforts on “the most significant and high-risk” healthcare issues, as follows.

Preventing and Treating Opioid Misuse: OIG used various investigative tools, including data analytics, to detect fraud and abuse, and brought civil, criminal and administrative enforcement actions to prevent fraud.

Protecting Children in the Department’s Care: OIG assessed the HHS Administration for Children and Families Office of Refugee Resettlement programs that are responsible for the shelter and care of unaccompanied alien children who enter the country without legal status.

Ensuring Quality of Care and Protecting Patients From Harm: OIG assessed safeguards to ensure quality and safety of care for Medicare and Medicaid patients, and studied the incidence and preventability of patient harm. In addition, OIG brought enforcement actions against healthcare providers who committed fraud that resulted in patient harm.

Ensuring Program Integrity and Effective Administration of the Medicare and Medicaid Programs: OIG worked to reduce improper payments and to ensure the Medicare funds were spent efficiently, effectively and economically. OIG also focused on fighting fraud, waste and abuse in the Medicaid program, and, in conjunction with those efforts, made recommendations to the Centers for Medicare and Medicaid Services (“CMS”) and the state Medicaid programs to correct problems and mitigate risks.

Protecting HHS Data, Systems, and Beneficiaries From Cybersecurity Threats: OIG worked to secure HHS IT systems, including the personal information collected and maintained by HHS programs. OIG also worked with the US Food and Drug Administration (“FDA”) to regulate the cybersecurity of medical devices.

Protecting the Integrity of HHS Grants and Contracts: OIG reviewed HHS grants and contract funds to ensure their appropriate and effective use.

The Report indicates that these activities have resulted in $496.42 Million in expected audit recoveries, $246.93 Million in questioned costs, and $776.58 Million in potential savings during the reporting period. In addition, the OIG investigative work led to $2.3 Billion in expected investigative recoveries, 421 criminal actions, 1,293 exclusions from healthcare programs, and 331 civil actions. Finally, the OIG reported 212 new audit and evaluation recommendations, and 186 recommendations implemented by HHS Operating Divisions.

At noted above, the OIG directs its efforts at the most significant and high-risk healthcare issues. Thus, healthcare providers and entities should review their practices, particularly with these focus areas, to ensure compliance with all relevant HHS, FDA and CMS regulations.