OIG Expects to Recover $5.9B in Healthcare Fraud

OIG Expects to Recover $5.9B in Healthcare Fraud

The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup as much as $5.9 billion in federal funds in 2019,

The semiannual report estimates the OIG will recover about $819 million from audits and more than $5 billion from investigative recoveries as a result of civil judgments, criminal actions, administrative actions by the OIG and administrative settlements.

Big Money Fraud Schemes

The OIG highlights in the report a “first of its kind” investigation into a genetic testing fraud scheme, which resulted in a $42.6 million settlement.

A $1.2 billion indictment was brought against a large telemarketing scheme where telemarketers would target Medicare patients from multiple call centers, offering “free or low cost” medical equipment regardless of medical necessity. The call centers then sold the orders they took to durable medical equipment companies, who fraudulently billed Medicare.

The Department of Justice also partnered with the OIG to obtain a $700 million False Claims Act settlement with Reckitt Benckiser Group plc (RB Group), a global consumer goods conglomerate. The settlement resolves allegations that the company illegally marketed and promoted Suboxone, an opioid treatment drug. The allegations included knowing promotion of Suboxone to physicians who were prescribing it in an unsafe manner. Additionally, the settlement was for making false and misleading claims to physicians, state Medicaid agencies, and the Food and Drug Administration to increase sales and delay generic competition.

CPB : Online Medical Billing Course

How Does 2019 OIG Recoveries Compare to Previous Years?

Fraud investigations totaled an estimated $2.9 billion in recoveries in 2018 and an estimated $4.4 billion in 2017, which included a $155 million settlement with electronic health record vendor eClinicalWorks and a $465 million settlement from Mylan for EpiPen misclassification. In 2016, the OIG estimated recoveries to total more than $5.66 billion, compared to $3.35 billion in 2015.

Barbara Cobuzzi

Barbara Cobuzzi

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers.Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.
Barbara Cobuzzi

About Has 103 Posts

Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, is a consultant with CRN Healthcare Solutions in Tinton Falls, N.J. She is consulting editor for Otolaryngology Coding Alert and has spoken, taught, and consulted widely on coding, reimbursement, compliance, and healthcare-related topics nationally. Barbara also provides litigation support as an expert witness for providers and payers. Cobuzzi is a member of the Monmouth, N.J., AAPC local chapter.

One Response to “OIG Expects to Recover $5.9B in Healthcare Fraud”

  1. Shirley Pina says:

    Job well done, as far as figuring out the Suboxune scams! Now more needs to be examined regarding how everyone else has jumped on the buph bandwagon. For some reason beuphornophine medications are being prescribed to chronic pain patients instead of their previously rapidly tapered opioid pain medications! This type of medicine is for those addicted to medications and more commonly known as street drugs. The opioid medications were in fact helping patients manage their chronic intractable pain with strict supervision from Pain management physicians for the most part several years. This being the last resort, became many patients life line in resuming some resemblance of a better standard of living finally. So because of and ever since the so-called opioid crisis began stemming from the CDCs Guidelines,( mind you thrown together with Suboxune products at the forefront leading the way for the panel PROP ,a group Of Physiatrist treating addiction in Rehabilitation centers only; Not in anyway related to legacy pain managed patients) causing numerous misapplications and adaptations throughout the medical field. There needs to be some recognition for this greedy behavior. I myself as a Pain patient have been put through this process of the overcharged Belbuca film. It was prescribed up to its maximum dosage of 900 mcg, as it does Not get calculated in the daily MME ,( imposed limitation of morphine milligrams equivalent) . There’s a substantial difference however with this type of medication in comparison to other analgesics. It blocks any other opioid medications from actually being effective for pain relief when taken together! How’s this acceptable? It’s not for Pain Relief whatsoever! It’s to help with withdrawals symptoms while detoxification is happening with someone wanting recovery from addiction. Plain and simple, This mentality of thinking that it’s a better alternative to FDA approved for centuries opioid medications is FALSE. Please look into stopping this madness because as I am all too familiar with this medications ability to block opioids, I wasn’t an addict needing it in a pain management setting. It’s a disgraceful way to be treated and needs more attention in changing the narrative and prescribing it for those it’s intended for. This notion now of thinking nobody should be using opioid medications is beyond comprehension and inhumane treatment. We’re NOT to be used for their money hungry gains!

Leave a Reply

Your email address will not be published. Required fields are marked *