HHS Releases OIG Seminannual Report to Congress

By Kelly A. Briganti, Editorial Director, G2 Intelligence

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) touted its efforts and achievements for the six-month period ending March 31, 2016—that is, the first half of the fiscal year 2016. The OIG is required by law to semiannually report to Congress about significant findings and recommendations.

The OIG’s most recent Semiannual Report to Congress, released May 31, reports the following enforcement results:

• $2.77 billion in recoveries ($554.7 audit receivables, $336.6 non-HHS investigative receivables such as Medicaid restitution)
• 428 criminal actions against individuals and entities
• 338 civil actions such as False Claims cases and Civil Monetary Penalties settlements and self-disclosure program recoveries
• 1,662 exclusions from federal health care programs.
• Strike Force efforts yielding 87 individuals and entities charged, 100 criminal actions and $116.8 million in investigative receivables.

The OIG reports “CMP recoveries have increased almost five fold over the past three years, and the OIG is on track to exceed prior recoveries in FY 2016.” In Inspector General Daniel R. Levinson’s introductory message to the report, he notes “OIG leverages technology and forensic audit techniques to identify and address emerging fraud trends and to support efforts to deter misconduct through administrative actions. OIG investigations, including Work on Strike Force cases, target emerging patterns of fraud and help to hold wrongdoers accountable.”

Enforcement cases highlighted within the report included sentencing of another individual in the Biodiagnostic Laboratory Services case. So far, 20 individuals have been sentenced according to the OIG for an aggregate of 41 years of prison. The case has also yielded $487,250 in fines and $510,695 in forfeiture and 15 exclusions for an aggregate of 111 years. The OIG also highlighted the Millennium Health $256 million False Claims Act settlement resolving allegations of medically unnecessary drug testing and genetic testing, and kickbacks to referring physicians.