OIG Highlights Hotline to Encourage Fraud Reporting

Reporting compliance concerns is a key component of effective compliance plans. A recent U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) podcast highlights the importance of the agency’s own compliance hotline in fighting fraud and abuse in Medicare and other HHS programs. The HHS has a $1 trillion budget and is largest grant maker in federal government according to the OIG podcast and its agencies and programs include not just Centers for Medicare & Medicaid Services and Medicare but also the National Institutes for Health, Centers for Disease Control & Prevention, the Food and Drug Administration, the Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration.

Diane Cutler, the OIG Hotline Director, explained during the podcast the value of the hotline to the agency’s oversight and enforcement efforts: “Tips from the public can help be a force multiplier for OIG in our oversight of HHS.” In Fiscal Year 2016, the hotline received 150,000 contacts, 20,000 of which were deemed “viable tips” that were reviewed by program managers and Special Agents. Nearly half of monetary and non-monetary results yielded in Fiscal Year 2016 criminal investigations and other cases could be linked to hotline reporting, according to Cutler:

• Of $45.8 million in monetary results for Fiscal Year 2016, $20 million could be attributed to hotline tips
• Of 57 non-monetary actions, 25 were derived from hotline tips.

The OIG encouraged individuals to report suspected fraud that involves HHS programs, participants or employees. Reports to the hotline need not be by telephone but can also be submitted by mail, fax, or online through the OIG website. Cutler noted that online reporting allowed submission of supporting documentation as well.

While reports can be made anonymously, Cutler pointed out that anonymity can hamper the agency’s ability to follow-up with tip-makers. Tips should include relevant dates and times and names of any potential involved or affected party which the agency can use to interview witnesses and review Medicare claims “to identify patterns or anomalies.”  Issues that aren’t appropriate for the OIG hotline include emergencies, personnel matters (discrimination complaints or grievances), equal employment and civil rights issues.