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Combating the Opioid Epidemic

Last Updated: 09-23-2024

Key Takeaways from the December 2023 report: The Consistently Low Percentage of Medicare Enrollees Receiving Medication to Treat Their Opioid Use Disorder Remains a Concern

OIG's Approach to Addressing the Opioid Epidemic

Addressing the opioid epidemic is a top priority for OIG. OIG's efforts fall in three areas:

  1. identifying opportunities to improve the efficiency and effectiveness of HHS programs;
  2. identifying and holding accountable those engaged in fraud; and
  3. empowering and collaborating with partners through data sharing and education.

OIG's actions in these areas advance prevention, detection, and enforcement of fraud, waste, and abuse in HHS programs that intersect with the opioid epidemic and help ensure quality care and treatment for those in need of services.

Identify Opportunities to Improve HHS Programs

Many HHS programs are involved with various aspects of the opioid epidemic, giving OIG opportunities to identify program improvements. Medicare, Medicaid and the Indian Health Service have influence over program integrity in prescription drug coverage; the Food and Drug Administration oversees new drug approvals and safety of existing drugs; and agencies such as the National Institutes of Health, Substance Abuse and Mental Health Services, and the Centers for Disease Control and Prevention award grants for education and treatment programs. Identifying opportunities to improve the effectiveness of HHS programs helps prevent waste, fraud, and abuse.

Reviews and Recommendations Relating to the Opioid Epidemic

Unimplemented Recommendations

Identify and Hold Accountable those Engaged in Fraud

Detecting Fraud

To help detect fraud, OIG deploys state-of-the-art data analytics and algorithms to identify the most egregious providers for further scrutiny or investigation by OIG and its partners.

In addition to leveraging data to detect fraud, OIG utilizes all advanced investigative techniques in its criminal, civil and administrative cases.

Enforcing Fraud Laws

To enforce laws, OIG may investigate cases on its own, or collaborate with its law enforcement partners. In the 2018 National Health Care Fraud Takedown, OIG and its law enforcement partners worked together to charge 601 defendants for opioids-related fraud related to prescribing patterns and to patient treatment.

OIG has the authority to exclude individuals and entities from participating in Federal health care programs if they are convicted of certain criminal offenses, including felony convictions related to controlled substance for individuals connected to the healthcare industry. In addition, OIG has discretion to exclude individuals and entities on a number of grounds, including misdemeanor convictions relating to controlled substances for individuals connected to the healthcare industry. In the 2018 National Health Care Fraud Takedown, OIG issued exclusion notices to 587 individuals based on their conduct related to opioid diversion and abuse.

Empowering and Collaborating with Partners through Data Sharing and Education

OIG recognizes that its data analytics capabilities and on-the-ground intelligence about fraud schemes and health care system vulnerabilities can support the efforts of other stakeholders in the fight against the opioid epidemic and its consequences.

OIG shares databases, statistics, risk score models, and methodology with other law enforcement partners, state entities, the Centers for Medicare and Medicaid Services, fraud organizations, and the Healthcare Fraud Public Private Partnership (HFPP). OIG has released toolkits to assist its public and private sector partners with analyzing their own prescription drug claims data and to help combat the opioid crisis. Through conference presentations, webinars, brochures, and podcasts, OIG also educates pharmacists, providers, and compliance officers about pharmaceutical fraud trends, recreational use of potentiator medications, case examples, and how to use data metrics to improve compliance reviews.