OIG Tells Congress Over $5 Billion Recovered
In its Semiannual Report to Congress, the Office of Inspector General (OIG) announced 2011 exclusions of 2,662 individuals and entities from participation in federal health care programs, and expected recoveries of approximately $5.2 billion in audit and investigative receivables.
The OIG also reported 723 criminal actions against individuals or entities that engaged in crimes against U.S. Department of Health & Human Services (HHS) programs and 382 civil actions, which included false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.
Among those programs that have contributed to its success, the OIG gave special mention to the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which coordinates law enforcement operations among federal, state, and local law enforcement entities; prescription drug investigations and reviews; and Medicare Part A and Part B reviews and enforcement actions (including those targeting skilled nursing facility (SNF) billing, oncology services, and durable medical equipment (DME) items).
Corporate integrity agreement enforcement activities also garnered special mention from the OIG. For instance, Church Street Health Management was penalized $230,000 because it did not comply with requirements of its corporate integrity agreements (CIAs) with OIG by failing to implement training, develop and distribute policies and procedures, submit an independent review organization (IRO) report, and provide notice of government investigations.
Addressing Congress, Inspector General Daniel Levinson expressed confidence that technology “has tremendous potential to enhance [the OIG’s] program integrity capabilities, citing such tools as data mining, predictive analytics, trend evaluation, and modeling” to better analyze and target oversight for HHS programs.
Future priorities for the OIG were identified as a continued focus on reducing improper payments, the public health and welfare of HHS beneficiaries, and protection of electronic patient health information. On this final point, OIG claims to have “a robust oversight agenda to ensure that sensitive information is protected from nefarious parties.”
The Semiannual Report to Congress keeps the HHS secretary and Congress up-to-date about OIG’s most significant findings, recommendations, and activities for specific six-month periods. Historically, approximately 80 percent of OIG’s resources are directed toward Medicare and Medicaid.