HHS-OIG Report to Congress Highlights Achievements in Tackling Fraud, Waste, and Abuse
The Department of Health and Human Services Office of Inspector General (HHS-OIG) has published its semi-annual report to Congress detailing HHS-OIG’s accomplishments in tackling fraud, waste, and abuse and promoting the economy, efficiency, and effectiveness of HHS programs.
Over the 6 months between October 1, 2023, and March 31, 2024, HHS-OIG’s enforcement efforts resulted in 712 civil and criminal actions, $2,76 billion in expected recoveries and receivables, and 1,795 bad actors were added to the HHS-OIG exclusion list, removing them from federally funded programs. The latter includes the owner of a medical supply company who was excluded from federal programs for at least 23 years after being convicted of conspiracy to commit health care fraud in a medically unnecessary durable medical equipment scheme.
Two of the most egregious cases investigated by HHS-OIG defrauded Medicare out of more than $203 million. A Florida nurse practitioner fraudulently billed Medicare for genetic testing and medical equipment that the Medicare beneficiaries did not need in a $192 million Medicare fraud scheme. She was convicted by a jury and sentenced to 20 years in jail and was ordered to pay more than $111 million in restitution. In another case, a Florida man and woman were sentenced to a total of 14 years and 2 months in prison after being found guilty of conspiracy to commit health care fraud and wire fraud, and conspiracy to commit money laundering. They ran a home health company that defrauded Medicare out of $96 million by billing for home health therapy services that were never provided.
HHS-OIG identified $101.4 billion in improper Medicare and Medicaid payments, which accounted for 43% of all improper payments across the Federal Government. They included $551.4 million that was claimed by Pennsylvania for its Medicaid school-based health services program and $41 million was recovered after 14 states were found to have made unallowable payments to Medicaid managed care organizations after enrolees’ deaths. Investigations by HHS-OIG found that some Medicare Advantage plans were receiving higher payments than they should have received due to submitting data that makes enrollees appear sicker than they are.
HHS OIG Exclusions List
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During the reporting period, HHS-OIG issued 60 audits and 18 evaluations to the HHS that included 195 new recommendations for correcting weaknesses, improving efficiency, and safeguarding taxpayer funds. These oversight and enforcement efforts provided a return on investment of around $10 for every $1 invested; however, HHS-OIG is underfunded. Its budget has not increased in line with the growth in the size and breadth of HHS programs and has therefore proposed an increase to its Fiscal Year 2024 budget to ensure that it can continue to safeguard taxpayer dollars and provide the necessary oversight to protect HHS programs and the individuals they serve.
