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Transcript for audio podcast: OIG Outlook 2013: Principal Deputy IG, Larry Goldberg

From the Office of Inspector General of Department of Health and Human Services

[Roberta Baskin] Joining me now is Larry Goldberg, our Principal Deputy Inspector General. In a sense, Larry is our chief operating officer and his job will be to coordinate the ambitious goals set in the work plan, among many other challenges. So, welcome Larry.

[Larry Goldberg] Thank you Roberta.

[Roberta Baskin] And with Health and Human Services programs accounting for almost one quarter of all Federal spending and touching the lives of virtually every American, how do you decide what the priorities are going to be in the year ahead?

[Larry Goldberg] Well, carrying out our mission in OIG to maximal impact really requires effective strategic planning and an agile response to unfolding events. Looking at the big picture, every year we assess the top challenges that are facing the department. So, for example, detecting and preventing fraud in the Medicare and Medicaid programs or protecting the nation's food supply. So, these become OIG priorities every year and also the areas that we recommend to the department, where they focus their attention, as well.

[Roberta Baskin] Well, the overwhelming body of OIG's work does focus on Medicare and Medicaid, but what drives that focus?

[Larry Goldberg] Well, Medicare and Medicaid are the largest programs that are operated by the department and together they serve one out of every four Americans. And congress created a special program called, "The Health Care Fraud and Abuse Control" program, specifically to attack fraud waste and abuse in the Medicare program. OIG gets about 80 percent of its resources from this program. So, we spent about 80 percent of our work focusing on Medicare and Medicaid issues.

[Roberta Baskin] Well, every year OIG issues its Work Plan in October. I'm curious, how do you take these big picture priorities and decide what you're going to focus on? How do you get to the details?

[Larry Goldberg] Sure, we are constantly assessing relative risks and potential impact. So, in other words we look to those areas where there's the greatest potential for fraud, waste and abuse and then we look to see where we can effectuate the most positive change. So, every time we start an audit or an evaluation we ask ourselves a number of questions. First of all, how many program dollars are at risk? How many individuals are affected by this particular program? Is anyone's life or health or safety at risk? And then do we have concerns because of previous work that we've done with respect to this program or that others have done? Now, in doing so we welcome input from the department, from congress, from the law enforcement community, health care providers and the public, because with our input that helps guide us to figure out what emerging trends there are, potential fraud issues and also where we should place our priorities.

[Roberta Baskin] The Work Plan details very specific projects when it comes to audits and evaluations and inspections. Although the public hears a lot about enforcement work, there's not so much detail about enforcement in the Work Plan. Why is that?

[Larry Goldberg] Right, well there are some good reasons why we don't talk about our enforcement activities and our investigations in our Work Plan. First of all, unlike audits and evaluations we don't plan our enforcement activities in advance. They really are the response to uncovering evidence of fraud. In addition, we don't really discuss our ongoing investigations or enforcement actions and that's for a couple of reasons. First of all, to protect the subject's due process rights during the course of the investigation and then to protect the investigation itself. If we're to be out there saying Dr. X is under investigation that could potentially compromise the investigation and lead to destruction of evidence and we might have an undercover operation going on in that case, as well.

[Roberta Baskin] Well, beyond responding to evidence of fraud then how do you plan enforcement action at a more strategic level?

[Larry Goldberg] We use data analysis, information from our agents in the field, our other government partners, vulnerabilities that we identify during the course of our audits and evaluations. All of this goes into planning our enforcement activities as well. So, for example, we establish Medicare fraud strike forces along with the Department of Justice in nine locations, the real fraud hotspots, and based on our data analysis and information from our agents, we figure out what the emerging fraud trends are and then we deploy our resources accordingly. We also very recently have focused on fraud by government contractors and grantees.

[Roberta Baskin] Larry, what do you see as the Work Plan's usefulness for various audiences? Are there any other resources that you want to highlight?

[Larry Goldberg] We recommend to our stakeholders that they use our Work Plan as a roadmap just to see where it is the OIG is focusing our attention. So, whether it's an HHS grantee or health care provider or someone subject to HHS regs, we recommend that people look at the questions we are asking in the Work Plan. So, for example, a hospital can look at some of the audits we are doing in the area of hospital billing. They can compare that to what they're doing in their own facilities and determine whether or not they're complying with Medicare rules. In addition, we report to congress twice a year on our completed work in these Semiannual Reports, different than our Work Plan, which is forward looking as to what we're going to do. It talks about the recommendations we've made, enforcement activities we've engaged in and what our findings are. And then once each year we publish a summary of our recommendations. Those have not yet been implemented by the department as to how the department can save money and improve programs.

[Roberta Baskin] Good information Larry. Thanks for your insights about what we're going to be doing in the year ahead.

[Larry Goldberg] Thank you Roberta.


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