BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

“America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.

The Fall 2022 Semiannual Report to Congress (SAR), in part, provides an overview of HHS-OIG’s activities for the reporting period comprising the last half of fiscal year (FY) 2022 from April 1 through September 30, 2022.

In addition to summarizing the reporting period’s achievements, the SAR details the impact of our work for the entire FY 2022. The report projects nearly $4 billion in expected recoveries resulting from HHS-OIG audits and investigations occurring between October 1, 2021 and September 30, 2022; over $1 billion is expected to be returned based on program audit findings, and approximately $3 billion is expected to be returned based on investigative work.

Also in FY 2022, HHS-OIG reported 710 criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. HHS-OIG also reported 736 civil actions, which include false claims and unjust-enrichment lawsuits filed in Federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. Our agency also excluded 2,332 individuals and entities from participation in Federal health care programs.”

Additional highlights of HHS-OIG’s work in the SAR include:

• OIG identified 1,714 providers out of approximately 742,000 whose billing for telehealth services during the first year of the COVID-19 pandemic posed a high risk to Medicare.
• OIG found that the National Institutes of Health (NIH) did not ensure that all clinical trial results were reported in accordance with Federal requirements.
• OIG found that one in four Medicare patients experienced harm events during their hospital stays in October 2018.
• OIG developed a national snapshot of State agencies’ approaches to reporting and locating children missing from foster care.  
• OIG assessed the Food and Drug Administration’s (FDA’s) repeated adaptation of its Emergency Use Authorization policies to address the need for COVID-19 testing.
• OIG partnered with HHS, the Department of Justice, U.S. Attorneys’ Offices, Federal Bureau of Investigation, and State and local law enforcement on Medicare Fraud Strike Force Teams.
• OIG used its authorities to pursue affirmative administrative action against entities and individuals engaging in conduct that violated the Civil Monetary Penalties Law.

“During FY 2022, HHS-OIG made 445 new audit and evaluation recommendations, which are crucial to encourage improvement in HHS programs. Meanwhile, HHS operating divisions implemented 431 prior recommendations, leading to positive impact for HHS programs and beneficiaries.”

For additional information on HHS-OIG’s ongoing and completed work, visit oig.hhs.gov.