OIG Celebrates 40 Years of Fraud Fighting

Oct. 15, 2016 marks 40 years since the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) was launched in 1976. It is now the largest inspector general with 1,600 employees and 70 offices and oversees $1 trillion in spending. The HHS OIG is charged with fighting fraud, waste and abuse in federal health care programs—primarily Medicare and Medicaid, but it also oversees the Centers for Disease Control and Prevention and the Food and Drug Administration. Here are some highlights about the agency’s recent successes:

• The OIG reports a return on investment of $6.10 for each dollar spent
• For the first half of 2016, the agency expects about $2.77 in recoveries
• The OIG’s claims its report recommendations yielded $20.6 billion in savings for fiscal year 2015

The OIG’s 2017 budget request totaled $419 million including $334 million for Medicare and Medicaid oversight and the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative. Enforcement targets include “fraud and wasteful spending, including improper payments, unsafe or poor quality health care and security of data and technology.” See “Labs and Diagnostics Central to 2017 Federal Budget Requests,” NIR, March 3, 2016. The OIG consistently includes clinical laboratory billing in its enforcement priorities yet has also offered significant guidance through compliance program guidance documents, special fraud alerts and advisory opinions. For further discussion of OIG-issued compliance guidance, alerts and advisory opinions as well as an overview of the agency’s enforcement efforts targeting labs, see Lab Compliance Essentials 2017: Managing Medicare Fraud & Abuse Liability Risk.