America’s taxpayers could recoup nearly $3 billion in misspent Medicare, Medicaid, and other health and human services funds as a result of work by HHS-OIG
The Spring 2022 Semiannual Report to Congress (SAR) highlights nearly $3 billion in expected recoveries as a result of HHS-OIG audits and investigations. The report also provides an overview of HHS-OIG’s activities from October 1, 2021, through March 31, 2022.
In the six month period covered in the SAR, HHS-OIG reported 320 criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. HHS-OIG also reported 320 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 1,043 individuals and entities from participation in Federal health care programs.
“We rigorously analyze data to detect concerning trends and outliers, issue compliance guidance for the health care industry, and make recommendations to HHS to improve program integrity,” said Christi A. Grimm, HHS Inspector General. “OIG’s deep expertise in fraud, waste, and abuse enables us to offer HHS and its operating divisions technical assistance to design safeguards that mitigate risk in new and expanded programs.”
Additional highlights of HHS-OIG’s work in the SAR include:
OIG found that COVID-19 tests drove an increase in total Medicare Part B spending on laboratory tests in 2020. At the same time, non-COVID-19 tests decreased significantly. Medicare Part B spent $1.5 billion on COVID-19 tests in 2020, while spending on non-COVID-19 tests decreased by $1.2 billion. In total, laboratory spending increased by 4 percent, but the decrease in utilization of non-COVID-19 tests raises concerns about potential impacts on beneficiary health. (See report OEI-09-21-00240.)
OIG found that from March through December 2020, 84 percent of Medicare beneficiaries received telehealth services from providers with whom they had an established relationship. On average, these beneficiaries tended to see their providers in person about 4 months prior to their first telehealth service. Beneficiaries enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage. (See report OEI-02-20-00521.)
OIG found that more than half of States failed to meet performance measures for their oversight of nursing homes in three or four consecutive years during FYs 2015–2018. State surveys of nursing homes are the primary safeguard for ensuring quality of care and resident safety. States’ most commonly missed performance measures related to survey timeliness. The remedy that the Centers for Medicare & Medicaid Services (CMS) consistently imposed on States for missing performance measures was requiring submission of corrective action plans. However, 10 percent of plans were missing from CMS files and many others lacked substantive details. In three States, CMS escalated concerns about performance to senior State officials, but it rarely imposed formal sanctions and never initiated action to terminate any of its agreements with States for conducting surveys. (See report OEI-06-19-00460.)
OIG found that 1,178 children were separated from a parent or legal guardian and referred to the Office of Refugee Resettlement’s (ORR’s)care between June 27, 2018, and November 15, 2020. Seventy percent of separated children referred to ORR care had been separated by immigration officials because of a parent’s criminal history. Additionally, separated children spent longer in ORR’s care and were less likely than non-separated children to be released to a sponsor. Of the 1,178 separated children referred to ORR during this time period, 182 children (15 percent) were reunified with the parent from whom the child was separated. (See report OEI-BL-20-00680.)
OIG found that of the roughly 1 million Medicare beneficiaries diagnosed with opioid use disorder in 2020, less than 16 percent received medication to treat it. Further raising concerns that beneficiaries face challenges accessing treatment, less than half of beneficiaries who received medication to treat opioid use disorder also received behavioral therapy. We also found that beneficiaries in Florida, Texas, Nevada, and Kansas were less likely to receive medication to treat their opioid use disorder than beneficiaries nationwide; that Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries; and that older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder. (See report OEI-02-20-00390.)
During the spring SAR reporting period, HHS-OIG made 130 new audit and evaluation recommendations, which are crucial to encourage positive change in HHS programs. Meanwhile, HHS operating divisions implemented 265 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.