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Taxpayers Could Save Nearly $4 Billion Dollars as a Result of HHS-OIG Work in FY 2021

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media@oig.hhs.gov

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America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.

The Fall 2021 Semiannual Report to Congress (SAR) highlights nearly $4 billion in expected recoveries as a result of HHS-OIG audits and investigations conducted during fiscal year (FY) 2021.

In addition to summarizing the full year’s achievements, the SAR provides an overview of HHS-OIG’s activities for the reporting period comprising the last half of FY 2021 (April 1 through September 30).

“For 45 years, our agency has been at the forefront of the fight against waste, fraud, and abuse in Medicare, Medicaid, and other HHS programs. And during these challenging times, our mission to protect the public and taxpayer dollars is more important than ever," said Christi A. Grimm, OIG’s Principal Deputy Inspector General. "As detailed in this report, our agency has achieved exceptional results in the past year, including making significant strides to safeguard the integrity of HHS programs and the health and well-being of the people that those programs serve.”

The report projects that for FY 2021 approximately $787 million is expected be returned based on program audit findings and $3 billion is expected to be returned based on investigative work.

In FY 2021, HHS-OIG reported 532 criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. HHS-OIG also reported 689 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. Our agency also excluded 1,689 individuals and entities from participation in federal health care programs.

Additional highlights of HHS-OIG’s work in the SAR include:

HHS-OIG found that COVID-19 had a devastating impact on Medicare beneficiaries in nursing homes in 2020. Two in five Medicare beneficiaries in nursing homes either had or likely had COVID-19 in 2020. Overall mortality in nursing homes increased to 22 percent in 2020 from 17 percent in 2019, with almost 1,000 more beneficiaries dying per day in April 2020 than in April 2019. About half of Black, Hispanic, and Asian beneficiaries in nursing homes either had or likely had COVID-19, compared to 41 percent of White beneficiaries. (See report OEI-02-20-00490.)

HHS-OIG published a toolkit compiling insights from its oversight of the Unaccompanied Children (UC) Program. These insights are drawn from audits and evaluations conducted since 2008, including reports issued following site visits at 45 facilities during the 2018 surge of children entering the UC Program. This toolkit outlines immediate actions that HHS program officials and facility administrators can take to ensure the health and safety of children in care, especially children at influx care facilities and emergency intake sites. (See report OEI-09-21-00220.)

HHS-OIG found that the Medicare program lacks consistent oversight of cybersecurity for networked medical devices in hospitals. The Centers for Medicare & Medicaid Services’ survey protocols for overseeing hospitals do not include requirements for networked device cybersecurity capabilities. Additionally, accrediting organizations do not use their discretion when performing surveys to require cybersecurity plans for these devices, although they do sometimes review limited aspects of device cybersecurity. (See report OEI-01-20-00220)

HHS-OIG found that states reported multiple challenges with using telehealth to provide behavioral health services to Medicaid enrollees in managed care organizations. The challenges included a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers. Some states also reported other challenges, including a lack of licensing reciprocity and difficulties with providers obtaining informed consent from enrollees. (See report OEI-02-19-00400.)

HHS-OIG investigated COVID-19-related schemes to fraudulently bill Medicare for medically unnecessary testing and medical equipment. HHS-OIG, along with our law enforcement partners, participated in a strategically coordinated, six-week federal law enforcement action to combat health care fraud nationwide. The efforts resulted in criminal charges against 138 defendants, including more than 42 doctors, nurses, and other licensed medical professionals, for over $1.4 billion in alleged losses. (See enforcement action details.)

During the fall SAR reporting period, HHS-OIG made 276 new audit and evaluation recommendations, which are crucial to encourage positive change in HHS programs. Meanwhile, HHS operating divisions implemented 238 prior recommendations, leading to positive impact for HHS programs and beneficiaries.

For additional information on HHS-OIG's ongoing and completed work, visit OIG.HHS.GOV.