OIG Testimony Hints to 2011 Work Plan
Office of Inspector General (OIG) investigations in 2009 resulted in $4 billion in health care fraud settlements and court-ordered returns, and this is just the “tip of the iceberg,” Inspector General Daniel R. Levinson said in his March 4 testimony before the subcommittee on Labor, Health and Human Services, Education, and related agencies of the House Committee on Appropriations.
“More disturbing,” said Levinson, “even if the rate of fraud remains constant, as health care expenditures continue to rise, the financial impact of health care fraud will continue to increase.”
To counter this trend, Levinson said the OIG will make the most of its proposed $272 million budget for 2011 to expand its activities in support of the joint Health and Human Services and Department of Justice (HHS-DOJ) Health Care Fraud Prevention and Enforcement Action Team (HEAT), including expanding the OIG-DOJ Medicare Fraud Strike Forces to 13 new locations.
Levinson said that the OIG also will continue to combat fraud using its “comprehensive strategy of prevention, detection, and enforcement” based on the following five principles:
- Enrollment. Scrutinize individuals and entities that want to participate as providers and suppliers prior to their enrollment in the health care programs. Levinson said the OIG will continue to monitor the effectiveness of provider enrollment safeguards.
- Payment. Establish payment methodologies that are reasonable and responsive to changes in the marketplace and medical practice. Levinson said the OIG has recommended cost-cutting measures, such as capping rental of oxygen concentrators at 13 months instead of 36 months.
- Compliance. Assist health care providers and suppliers in adopting practices that promote compliance with program requirements. The OIG recommends providers and suppliers be required to adopt compliance programs as a condition of participating in the Medicare and Medicaid programs.
- Oversight. Vigilantly monitor the programs for evidence of fraud, waste, and abuse.
- Response. Respond swiftly to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities.
Levinson’s testimony goes on to tout the effectiveness of the Health Care Fraud and Abuse Control (HCFAC) program and its successes in cooperation with the HEAT program.
Read Inspector General Levinson’s full testimony.