OIG Issues Semiannual Report

Key Points:

• $566.46 million in expected recoveries from audit results.
• $1.37 billion in expected investigative recoveries.
• 221 criminal actions.
• 272 civil actions.
• 1,036 individuals and entities excluded.   

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) issued the Semiannual Report to Congress for the six-month period of October 1, 2020 to March 31, 2021. The report includes highlights of the OIG’s accomplishments, such as the issuance of 75 audit reports and 20 evaluation reports. The OIG’s audit work identified $566.46 million in expected recoveries stemming from alleged violations of laws and regulations, lack of documentation support, or unnecessary or unreasonable expenditures. It also identified nearly one billion dollars in potential savings that could result if HHS implements all the related recommendations. In addition, the OIG also made 228 new audit and evaluation recommendations to HHS agencies to make positive changes to their programs. 

In partnership with other agencies and law enforcement entities, the OIG has also continued to detect, investigate, and prosecute fraud. These efforts led to $1.37 billion in expected investigative recoveries and 221 criminal actions during the reporting period. In addition, the OIG took 272 civil actions (including the assessment of monetary penalties) and excluded 1,036 individuals and entities from federal health care programs.  

The report also discusses the OIG’s enforcement efforts related to the COVID-19 pandemic. They include the following:

• Analyzing nursing home surveys for improvement opportunities;
• Conducting a nationwide “pulse survey” of hospitals responding to the COVID-19 pandemic;
• Engaging with nursing homes and emergency medical services (EMS) providers throughout the country to help them report allegations of unsafe practices;
• Co-leading the first report by the Pandemic Response Accountability Committee (PRAC) Health Subcommittee focused on COVID-19 testing data across six federal programs; and
• Alerting the public about fraud schemes related to COVID-19.

For more information on this topic, please contact Richard Kusserow at [email protected].

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 2,000 health care organizations and entities in developing, implementing and assessing compliance programs.