A recent report reveals that in a recent six-month period, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) made strides in combating fraud, waste, and abuse within HHS programs.
What’s happened
The HHS OIG report reveals that they have successfully taken legal action against numerous violators, resulting in many individuals and entities being banned from participating in federally funded programs after being added to the HHS-OIG exclusions list. This included a medical supply company owner who was involved in a scheme that provided unnecessary equipment.
The OIG also identified issues with improper Medicare and Medicaid payments, including cases where payments were made for deceased enrollees. They conducted numerous audits and evaluations, issuing recommendations to address weaknesses and improve efficiency. Despite their success, the OIG noted a need for increased funding to match the expanding scope and demands of HHS programs.
The backstory
The HHS exclusion list acts as a powerful safeguard, barring individuals and entities from participating in federally funded health programs like Medicare and Medicaid if they've been caught engaging in fraud or misconduct. Being placed on this list is necessary as it cuts off access to federal funds for those who have misused them, stopping bad actors from further harming these health services.
By adding numerous offenders to this exclusion list, the HHS makes a clear statement: only those who play by the rules are welcome, ensuring that taxpayer money supports legitimate, trustworthy healthcare services for all who rely on them. This proactive measure is key to maintaining the integrity and financial health of vital public health programs.
See also: Basics of risk management security | HHS
By the numbers
- Civil and criminal actions: 712 actions taken.
- Financial recoveries: $2.76 billion in expected recoveries and receivables.
- Exclusions: 1,795 individuals added to the HHS-OIG exclusion list.
- Major fraud cases:
- A nurse practitioner involved in a $192 million Medicare fraud scheme.
- A couple ran a home health company that defrauded Medicare out of $96 million.
5. Improper Payments:
- Total identified improper Medicare and Medicaid payments amounted to $101.4 billion.
- $551.4 million claimed improperly by Pennsylvania for Medicaid school-based health services.
- $41 million recovered from 14 states for unallowable payments to Medicaid managed care organizations after enrollees' deaths.
6. Oversight reports: 60 audits and 18 evaluations issued.
7. Return on investment: Approximately $10 returned for every $1 invested in OIG oversight and enforcement efforts.
See also: What are the penalties for HIPAA violations?
What was said
In the report, Inspector General Christi A. Grimm stated, “OIG scrutinizes all corners of the Medicare and Medicaid programs, with a focus on promoting sound financial stewardship, ensuring access to high-quality and safe care, and holding wrongdoers accountable. Oversight of managed care—a rapidly changing sector with significant emerging risks—continues to be a priority. “
See also: HIPAA Compliant Email: The Definitive Guide
FAQs
What is the function of the HHS OIG?
The HHS OIG oversees the integrity of Health and Human Services programs.
What is the purpose of Medicaid?
Medicaid provides health coverage to low-income individuals and families.
Who benefits from the crackdown on the HHS OIG recovery of finances?
Taxpayers and beneficiaries of federally funded health programs benefit from the HHS OIG's financial recoveries, as these actions safeguard public funds and enhance the quality and efficiency of health services.
Kirsten Peremore
