The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report to Congress for the reporting period of October 1, 2019 through March 31, 2020. The Semiannual Report details work done by the OIG to uncover and prevent risks, abuse, waste and fraud, including recent audits and reports relating to the administration of HHS programs. Overall, the OIG issued 81 audit reports, 14 evaluations, potentially saved $911.3 million, and is expected to recover $605.2 million from its audits for this reporting period.
During this reporting period, the OIG continued to provide data to policymakers on opioids prescriptions and treatments, while prioritizing the fight against opioid-related fraud. Investigations conducted by the OIG aided in the conviction of a doctor that was prescribing and distributing large amounts of prescription opioids, along with a provider running a “pill mill” in Virginia which patients traveled long distances to and paid cash for opioid prescriptions. Additionally, the OIG uncovered an estimated $39.3 million in Federal Medicaid reimbursements for opioid treatment programs that were improperly claimed by New York State as a result of inadequate documentation of services by providers.
In the wake of COVID-19, the OIG quickly recognized the potential for fraudulent schemes and has accordingly focused its attention on investigating fraudulent marketing schemes related to COVID-19 testing, false claims, and identity theft. The OIG jumped into action and implemented a reporting system related to COVID-19 fraud, assessed the test kits provided by CDC, and created a Policy Statement that waived cost-sharing requirements for telehealth services.
The OIG outlines in the Semiannual Report the extensive work it has done to protect against unnecessary increases in Medicare costs due to illegal activity, such as recommending that Medicare Part D be allowed to utilize pharmacy enrollment, revocation, and preclusion tools that other parts of Medicare are allowed to use in order to protect against pharmacy fraud. The OIG has taken steps to protect taxpayer dollars after discovering that terminated providers were still enrolled in State Medicaid programs and were linked to $50.3 million in Medicaid payments.
Additionally, the OIG has maintained in its Semiannual report that it remains committed to protecting the beneficiaries of HHS programs, including vulnerable people in facilities and home-based programs, while ensuring that Medicare and Medicaid funds are spent as they are required to be spent.
For more details on the findings of the OIG during this reporting period, please see the “Medicare and Medicaid Reports and Reviews” section of the OIG’s Semiannual Report to Congress.
Colleen R. Pierson, Law Clerk, contributed to this article. If you have any questions please contact David R. Ross, Esq., Senior Shareholder, via e-mail at firstname.lastname@example.org.