Part B Insider (Multispecialty) Coding Alert

Here’s a Breakdown of the Latest Enforcement Numbers

Published on Tue Jul 13, 2021

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Compare and contrast the last two reporting period stats during COVID.

Despite being in the middle of a once-in-a-lifetime pandemic, the HHS Office of Inspector General (OIG) was awfully busy racking up its enforcement numbers.

In the latest Semiannual Report to Congress, which covers Oct. 1, 2020, through March 31, 2021, the national watchdog didn’t let the COVID-19 public health emergency (PHE) get in the way of its significant oversight or enforcement duties. Take a look at the statistics over the six-month timeframe as well as comparisons with the prior period (April 1, 2020, to Sept. 30, 2020), according to data from the last two OIG briefs:

Audits: OIG released 75 audit reports and 20 evaluations. These figures were down from the previous reporting period — April 1, 2020, through Sept. 30, 2020 — in which OIG issued 97 audit reports and 27 evaluations.
Expected recoveries: The agency’s audit work was substantial, with expected recoveries at $566.46 million. The agency did not list questioned costs in the latest report.
Investigative recoveries: OIG anticipated its investigative recoveries at $1.37 billion during the reporting period, which was slightly down from the previous six-month reporting period amount of $1.62 billion.
Criminal actions: According to the report, OIG brought criminal actions against 221 individuals and entities. This was up from 181 criminal actions for the April 2020 to Sept. 2020 duration.
Civil actions: OIG levied civil actions against 272 individuals and entities compared to 421 civil actions in the prior six-month reporting period.
Exclusions: The feds excluded 1,036 individuals and entities from federal healthcare programs between Oct. 1, 2020, and March 31, 2021, while 1,245 exclusions occurred during the previous reporting cycle.