HHS-OIG Expects to Recover $7.13 Billion in FY 2024
The Department of Health and Human Services Office of Inspector General (HHS-OIG) expects to recoup $7.13 billion in recoveries and receivables in FY 2024 from its investigations and audits, according to its Fall 2024 semiannual report to Congress.
Those funds came from 1,548 criminal and civil enforcement actions against individuals and companies suspected of engaging in crimes targeting HHS programs and the people they serve. In many cases, the investigations resulted in civil monetary penalties and criminal convictions, with 3,234 individuals added to the HHS-OIG exclusion list having been barred from participating in federal healthcare programs. The $7.13 billion includes around $4 billion in recoveries and receivables from investigations and audits conducted in the 6-month period between April 1, 2024, and September 30, 2024.
The June 2024 National Health Care Fraud Enforcement Action saw HHS-OIG, the Department of Justice, and Federal, State, and local law enforcement partners charge 193 individuals for their roles in fraud schemes, including fraudulent billing for products and services that were unnecessary or never provided, the unlawful distribution of medications over the Internet, distribution of adulterated and misbranded HIV medications, and many kickback schemes. Those crimes involved around $2.75 billion in unintended losses to government programs and taxpayers.
One of the main areas investigated by HHS-OIG relates to durable medical equipment, which is particularly vulnerable to criminal schemes. One of the key enforcement highlights in this area was a scheme operated by two brothers who used telemarketing strategies to bribe physicians into ordering unnecessary durable medical equipment. The enforcement action resulted in jail terms for the brothers and an order to pay more than $424 million in restitution. Another enforcement action against a nurse practitioner who engaged in a durable medical equipment fraud scheme saw her added to the HHS-OIG exclusion list and ordered to pay $192 million in restitution. HHS-OIG investigations of potential fraud schemes and audits to identify misspent taxpayer dollars consistently achieve a return on investment of around $10 for every $1 invested.
HHS OIG Exclusions List
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In addition to financial recoveries, HHS-OIG’s audits and investigations uncover noncompliance with federal regulations and areas where HHS programs need to be improved. For instance, an HHS-OIG investigation determined that many states lack the necessary information to monitor maltreatment in residential facilities for children in foster care and states could better leverage MCO provider coverage requirements and network adequacy standards to promote access to maternal health care.
