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HHS OIG Reports Expected Investigative Recoveries of $2.91 Billion in FY 2018

The Office of Inspector General for the Department of Health and Human Services recently published its Semiannual Report to Congress, for the period April 1 to September 30, 2018. The report highlights, among other things, OIG’s continued rigorous investigation of fraud and abuse perpetrated against federal health care programs.

In FY 2018, OIG reported investigative recoveries amounting to $2.91 billion, criminal actions against 764 individuals or entities that allegedly committed crimes involving HHS programs, exclusion of 2,712 individuals and entities, and civil actions against 813 individuals or entities.

OIG credited its cooperative work with DOJ, state Medicaid Fraud Control Units, and other federal, state, and local agencies. The report touted OIG’s work with state and federal law enforcement partners during the nationwide healthcare fraud takedown in June 2018, which resulted in charges against more than 600 defendants in 58 federal districts relating to alleged health care fraud schemes involving more than $2 billion.

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During FY 2018, OIG also issued 163 audit reports and 45 evaluations, resulting in 578 new recommendations to HHS operating divisions, the report noted. The operating divisions implemented 420 recommendations during that period. During the semiannual reporting period alone, OIG issued 80 audit reports and 32 evaluations, resulting in 320 new recommendations issued to HHS operating divisions. The operating divisions implemented 236 audit and evaluation recommendations during the reporting period.

In FY 2018, OIG also reported expected audit recoveries of $521 million and issued reports with $2 billion in questioned costs. This included unauthorized financial assistance payments to health plan issuers totaling nearly $940 million and $180 million in unallowable Medicaid reimbursements for specialty mental health services, the report indicated.

Inspector General Daniel R. Levinson stated: “We focus on achieving positive outcomes in established priority areas such as the opioid epidemic, Medicaid fraud, the safety of children, and home- and community-based services, as well as emerging areas such as cybersecurity and the shift to value-based care. We remain a nimble organization well prepared to address emergent oversight needs, including emergency preparedness and response.”

Click here to read the report.


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