Health Law Daily HHS OIG gives Congress update on actions against fraud, abuse
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Tuesday, June 4, 2019

HHS OIG gives Congress update on actions against fraud, abuse

By Cathleen Calhoun, J.D.

HHS Inspector General Daniel R. Levinson presents his final semiannual report to Congress.

The Office of Inspector General (OIG) worked to find risks, problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs and operations during the reporting period of October 1, 2018, through March 31, 2019, leading to $2.3 billion in expected investigative recoveries. The OIG mentioned that it also specifically focused on the opioid crisis and quality of care, along with cybersecurity and children cared for in resettlement facilities, during the reporting period. The current Inspector General, Daniel R. Levinson, said that this will be his final semiannual report submission to Congress as Inspector General of HHS (OIG Semiannual Report to Congress, June 1, 2019).

Program integrity. OIG recommended that Medicaid overpayments be recovered by CMS since $1.6 billion in overpayments is due to the federal government. For example, according to OIG, California made Medicaid payments of $959.3 million ($536 million federal share) for 802,742 ineligible beneficiaries. In addition, California made $4.1 billion ($2.6 billion federal share) on behalf of 3.1 million potentially ineligible beneficiaries. OIG recommends that California do a redetermination of eligibility of the sampled beneficiaries.

Opioid crisis. The OIG reported that results of its work relating to the opioid crisis during this semiannual reporting period included:

  • New York did not adequately steward substance abuse prevention and treatment block grant funds. New York failed to trace funds to a level of expenditure adequate to establish that the funds were used for the program’s intended purpose.
  • A California physician assistant was found guilty of conducting a scheme to unlawfully distribute prescription drugs, resulting in a 10-year sentence.

Health care fraud. Medicare Fraud Strike Force teams—partnerships among OIG and HHS, DOJ, U.S. Attorneys’ Offices, the Federal Bureau of Investigation (FBI), and state and local law enforcement to prevent and combat healthcare fraud, waste, and abuse—had success. During this semiannual reporting period, Strike Force efforts resulted in the filing of charges against 47 individuals or entities, 139 criminal actions, and more than $146.6 million in investigative receivables.

Medicare and Medicaid legal actions and activity. OIG said that its largest body of work involves investigating matters related to Medicare and Medicaid, and that the most common type of fraud is the filing of false claims for reimbursement. During this reporting period, OIG reported:

  • 394 criminal and 327 civil actions against individuals or entities that engaged in offenses related to healthcare.
  • Over $2.05 billion in investigative receivables due to HHS.
  • Over $246.6 million in non-HHS investigative receivables, including civil and administrative settlements or civil judgments related to Medicare, Medicaid, and other federal, state, and private healthcare programs.

MainStory: TopStory OIGReports ACONews CMSNews BillingNews ControlledNews DrugBiologicNews EnforcementNews FCANews FraudNews MedicaidNews EligibilityNews MedicaidPaymentNews ProgramIntegrityNews QualityNews

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