Health Reform WK-EDGE HHS OIG releases semiannual report to Congress
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Wednesday, December 16, 2020

HHS OIG releases semiannual report to Congress

By Wendy Biddle, J.D.

The pandemic dominated the attention of the OIG for the last six months.

The Office of Inspector General (OIG) of HHS submitted its most recent report to Congress summarizing its activities over the last six months. Although the pandemic response dominated the office, the report also highlighted the many audits and investigations the office has conducted which is expected to result in billions of recovered monies from over 150 criminal actions and thousands of civil actions and individual exclusions from federal healthcare programs (OIG Semiannual Report to Congress, December 2, 2020).

The OIG provides independent oversight of HHS programs and operations and conducts audits of programs, evaluations of issues, and investigations of civil and criminal misconduct. Every six months the office prepares a report for Congress on their activities.

Pandemic response. The OIG COVID-19 strategic plan outlined four goals: protect people, protect funds, protect infrastructure, and promote program effectiveness. The OIG reported it provided information about hospitals’ experiences and perspectives in responding to the COVID-19 pandemic, including in testing and care strategies for people with the virus. The OIG also exercised its enforcement discretion to not impose administrative sanctions under the federal anti-kickback statute for certain remuneration related to COVID-19 covered by the blanket waivers of the Social Security Act.

Similarly, physicians and other practitioners were notified they also would not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations that a beneficiary might owe for telehealth services during this public health emergency. The OIG also issued two toolkits for health care facilities and community leaders to help with the response events. The toolkits contained insights on preparedness and response from past outbreaks and natural disasters.

Audits and investigations. In September 2020, the office carried out the largest takedown in DOJ history resulting in charges against 345 people for submitting more than $6 billion in false and fraudulent health care claims, including $845 million connected to substance abuse treatment facilities.

The OIG also found that hospitals overbilled Medicare $1 billion by incorrectly assigning severe malnutrition diagnosis codes to inpatient hospital claims. Medicare also overpaid more than $267 million for hospital inpatient claims when those patients were transferred home and resumed home health services. The hospitals failed to code the transfer correctly, resulting in an overpayment.

Overall, the OIG issued 178 audit reports and 44 evaluations that expect to result in $942 million recovered for the agency. This reporting period, the OIG made 416 new audit recommendations. Through those audits, the OIG identified $2 billion in potential savings for HHS, if HHS implements all of the audit recommendations.

Other highlights. The report highlights several of HHS’ programs and services, like the Unaccompanied Alien Children Program, which the OIG found that improvements were needed to better protect children and to make certain that the program funds are being used appropriately. The report also highlighted that opioid use has steadily declined in Medicare Part D and use of drugs for medication-assisted treatment has increased, but recommended that CMS closely monitor opioid use.

The OIG further identified opportunities where HHS can strengthen its overall IT security program, acknowledging that HHS has made cybersecurity improvements but certain weaknesses remain.

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