Taxpayers Could Save Nearly $4 Billion Dollars as a Result of HHS-OIG Work, New Report Says

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 2022 Semiannual Report to Congress (SAR), in part, provides an overview of HHS-OIG’s activities for the reporting period comprising the last half of fiscal year (FY) 2022 from April 1 through September 30, 2022.

“HHS-OIG continues to provide essential, data-driven oversight and enforcement to drive positive change in HHS programs and for individuals they serve,” said Christi A. Grimm, OIG’s Inspector General. "This report describes pragmatic and meaningful progress resulting from the diligent work and unwavering dedication of HHS-OIG’s workforce. I am confident that the effects of our efforts during the reporting period– which include recommendations to improve nursing home life safety and emergency preparedness, recovery of over a billion dollars in taxpayer funds, and the exclusion of 1,290 individuals and entities from participating in Federal health care programs– resonate throughout all of HHS.”

In addition to summarizing the reporting period’s achievements, the SAR details the impact of our work for the entire FY 2022. The report projects nearly $4 billion in expected recoveries resulting from HHS-OIG audits and investigations occurring between October 1, 2021 and September 30, 2022; over $1 billion is expected to be returned based on program audit findings, and approximately $3 billion is expected to be returned based on investigative work.

Also in FY 2022, HHS-OIG reported 710 criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. HHS-OIG also reported 736 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 2,332 individuals and entities from participation in Federal health care programs.

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

OIG identified 1,714 providers out of approximately 742,000 whose billing for telehealth services during the first year of the COVID-19 pandemic posed a high risk to Medicare. Each of these 1,714 providers had concerning billing on at least 1 of 7 measures we developed that may indicate fraud, waste, or abuse of telehealth services. In addition, more than half of the high-risk providers we identified are part of a medical practice with at least one other provider whose billing poses a high risk to Medicare. Further, 41 providers whose billing poses a high risk appear to be associated with telehealth companies. Although these high-risk providers represent a small proportion of all providers who billed for a telehealth service, these findings demonstrate the importance of strong, targeted oversight of telehealth services. (See report OEI-02-20-00720.)

OIG found that the National Institutes of Health (NIH) did not ensure that all clinical trial results were reported in accordance with Federal requirements. NIH did not ensure that all NIH-funded intramural and extramural clinical trials complied with Federal reporting requirements for responsible parties to submit the results of clinical trials to ClinicalTrials.gov. The noncompliance with Federal reporting requirements occurred because NIH did not have adequate procedures for ensuring that responsible parties submitted the results of clinical trials, took limited enforcement action when there was noncompliance, and continued to fund new research of responsible parties that had not submitted the results of their completed clinical trials. (See report A-06-21-07000.)

OIG found that one in four Medicare patients experienced harm events during their hospital stays in October 2018. Patient harm events indicate that a patient’s care resulted in an undesirable clinical outcome not caused by underlying disease. Forty-three percent of these harm events could have been prevented. Our findings will help the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality track and reduce patient harm in hospitals and improve patient safety. (See report OEI-06-18-00400.)

OIG developed a national snapshot of State agencies’ approaches to reporting and locating children missing from foster care. All 50 State agencies said that they had implemented policies and procedures regarding measures to report and locate children missing from foster care. Some State agencies reported enhanced procedures when a high-risk child went missing, or they created special units or had specifically designated staff to help locate missing children. We identified several barriers and other deficiencies in State agencies’ policies and procedures. These barriers included limitations in State agencies’ data systems, lack of oversight to ensure timeliness when reporting missing children, and issues involving the collaboration and exchange of information with Federal agencies and law enforcement. (See report A-07-20-06095.)

OIG assessed the Food and Drug Administration’s (FDA’s) repeated adaptation of its Emergency Use Authorization policies to address the need for COVID-19 testing. From January through May 2020, FDA repeatedly adapted its approach to how it used Emergency Use Authorizations (EUAs) to address COVID-19 testing challenges; however, efforts to increase test availability sometimes came at a cost to test quality. Our findings underscore the need to apply insights from FDA’s early experiences with the COVID-19 pandemic toward current and future infectious disease emergencies to better balance test availability and quality. (See report OEI-01-20-00380.)

OIG partnered with HHS, the Department of Justice, U.S. Attorneys’ Offices, Federal Bureau of Investigation, and State and local law enforcement on Medicare Fraud Strike Force Teams. Medicare Fraud Strike Force teams combine resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse by analyzing health care fraud data and investigative intelligence to quickly identify fraud and bring prosecutions. During the SAR period, Strike Force efforts resulted in the filing of charges against 100 individuals or entities, 98 criminal actions, and more than $248.2 million in investigative receivables. (See details.)

OIG used its authorities to pursue affirmative administrative action against entities and individuals engaging in conduct that violated the Civil Monetary Penalties Law. For example, a physician entered into a $1,905,070.74 settlement agreement with OIG to resolve allegations of submitting false claims to Medicare for the application, monitoring, and removal of medical devices as well as improper claims for reimbursement of devices not covered by the Medicare program. (See details.)

During FY 2022, HHS-OIG made 445 new audit and evaluation recommendations, which are crucial to encourage improvement in HHS programs. Meanwhile, HHS operating divisions implemented 431 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.