The HHS Office of Inspector General’s (OIG’s) fiscal year (FY) 2018 budget request to Congress totals $359 million to provide oversight of HHS programs. This request is $18.1 million above the annualized FY 2017 Continuing Resolution (CR) post-sequester level. The budget request includes $68 million to support oversight of HHS's Public Health and Human Services (PHHS) programs and $291 million to support oversight of the Medicare and Medicaid programs, including law enforcement activities coordinated with HHS and the Department of Justice (FY 2018 OIG Budget Justification, May 23, 2017).
PHHS oversight. The OIG’s PHHS oversight activities include investigations, audits, evaluations, enforcement actions, and other compliance efforts. For FY 2018 PHHS oversight, the OIG requests $68.1 million and 315 full time equivalent (FTE) employees. This request is $8.3 million less and 30 FTEs below the FY 2017 level.
In FY 2018, the OIG plans to focus on the successful implementation by HHS of new authorities under the 21st Century Cures Act, which provided $1 billion in new grants for prevention and treatment of opioid addiction. The OIG also plans to continue its oversight activities from FY 2017, such as quality and safety in Indian Health Service facilities, fraud, waste, and abuse in grants and contracts, emergency preparedness issues, and the efficient and secure use of data and technology, including the smooth sharing of health information across the care continuum.
Medicare and Medicaid oversight. For its FY 2018 oversight of CMS programs, the OIG requests $290.7 million and 1,349 FTEs. This request is $26.4 million and 117 FTEs above the FY 2017 CR level. This $290.7 total is broken down as follows:
- $204.4 million ($18.5 million above the FY 2017 CR level) in Health Care Fraud and Abuse Control Program (HCFAC) Mandatory funds;
- $74.2 million in HCFAC Discretionary funds ($7.0 million above the FY 2017 CR level); and
- $12.0 million in estimated HCFAC Collections, which help reimburse the OIG for its costs of conducting investigations, audits, and compliance monitoring.
This CMS oversight funding level reflects increases in the HCFAC discretionary cap adjustment level in the Budget Control Act, projected increases based on the Consumer Price Index-Urban, and assumes that sequestration does not occur.
In FY 2018, the OIG plans to continue FY 2017 HCFAC oversight activities to target fraud, abuse, and wasteful spending in Medicare and Medicaid, including improper payments, home health fraud, prescription drug fraud, unsafe or poor quality health care, and security of data and technology. It also plans to continue using sophisticated data analytics and multi-disciplinary state-of-the-art investigative techniques to detect crime and conduct criminal investigations of fraud. The OIG plans to use additional funding to enhance its work to combat prescription drug fraud, including opioid abuse and associated patient harm.
FY 2016 OIG accomplishments. The OIG’s budget justification details some of its significant accomplishments in FY 2016, including monetary recoveries, exclusions, and civil and criminal actions against individuals and organizations. These accomplishments include:
- Expected recoveries of more than $5.66 billion, including $4.46 billion in investigative receivables, approximately $953 million in non-HHS investigative receivables resulting from OIG’s work in areas such as states’ share of Medicaid restitution, and nearly $1.2 billion in audit receivables.
- Obtained a return of $5 to the Medicare Trust Fund for every $1 invested as a HCFAC program participant.
- Excluded 3,635 individuals and organizations from participation in federal health care programs.
- Initiated 844 criminal actions against individuals and organizations engaged in crimes against HHS programs.
- Initiated 708 civil and administrative enforcement actions, including False Claims Act actions and civil money penalty law settlements.
- Concluded cases involving approximately $83 million in civil money penalties.
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