At the end of May 2021, the United States Health and Human Services Office of Inspector General (HHS OIG) released its Semiannual Report to Congress, outlining HHS OIG’s work from October 1, 2020, through March 31, 2021. In the report, Principal Deputy Inspector General Christi Grimm noted that HHS OIG is “aggressively investigating pandemic-related fraud that harms individuals and jeopardizes public health efforts.”
Financial Recoveries
During the timeframe covered by the report, HHS OIG issued 95 reports after auditing and evaluating select HHS programs, providing tips on how to improve efficiency and effectiveness – with an emphasis on preventing fraud and abuse. The reports found a substantial amount of money via expected recoveries, savings identified by HHS OIG, and investigative recoveries.
Those 95 reports identified more than $550 million in expected recoveries, including costs not supported by adequate documentation, expenditures where the intended purpose was unnecessary or unreasonable, and expenditures that were questioned by OIG because of an alleged violation. HHS OIG found another nearly $1 billion in savings for HHS, should the agency implement all of the audit and evaluation programs identified by OIG in the reports.
As far as investigative recoveries, HHS OIG worked with the Department of Justice, Medicaid Fraud Control Unites, and other various law enforcement agencies to investigate and prosecute fraud, resulting in $1.37 billion in expected investigative recoveries – and an astounding 221 criminal actions.
The Impact of COVID-19
As one might expect, as we taper back into “normal” life following the COVID-19 pandemic that consumed much of the reporting period, OIG implemented ways to promote the HHS COVID-19 response and recovery. Some of those methods include: (1) analyzing onsite surveys of nursing homes during the pandemic and identifying opportunities for infection control and ways to improve overall care provided to patients; (2) conducting a survey of hospitals better understand how health care delivery was strained due to the pandemic; (3) partnering with six other federal OIGs to analyze COVID-19 testing, including the amounts paid by Medicare Part B for these tests; and (4) educating the public about various types of fraudulent schemes relating to COVID-19.
OIG also found that the COVID-19 pandemic may result in Medicaid beneficiaries being put at a greater risk of opioid misuse/abuse – from January to August 2020, at least 5,000 Medicare Part D beneficiaries suffered opioid overdoses each month. In the report, HHS OIG emphasized the importance of CMS and HHS monitoring prescribing trends for medication-assisted treatment and naloxone, and to be prepared to take action if the number of prescriptions starts to wane.
HHS OIG also found that hospitals that had to operate in “survival mode” for an extended period throughout the pandemic have new challenges in health care delivery, health care access, and health outcomes. More specifically, hospitals have reported that staffing shortages have impacted the ability to provide patient care, and the exhaustion and trauma from working during a pandemic have affected the mental health of many hospital employees. Many hospitals also continue to report financial instability as a result of increased expenses related to the pandemic and lower revenues from the decreased use of other services.