The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Fall 2013 (April-September) Semiannual Report to Congress (Report). For fiscal year (FY) 2013, the OIG reported over $5.8 billion in recoveries, including nearly $850 million in audit receivables and about $5 billion in investigative receivables. The OIG also reported the exclusion of 3,214 individuals from participation in federal health care programs; 960 criminal actions for HHS program-related crimes; and 472 civil actions, including federal false claims and unjust enrichment lawsuits, civil monetary penalty settlements, and provider self-disclosure matters resulting in administrative recoveries.
The Report also highlights the success of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), OIG’s partnership with other federal, state, and local law enforcement entities. HEAT Strike Force efforts during fiscal year 2013 resulted in charges filed against 274 individuals or entities, 251 criminal actions, and $333 million in investigative receivables. In May 2013, Strike Force operations in eight cities coordinated a nationwide takedown resulting in charges against 89 doctors, nurses, and other licensed medical professionals, related to Medicare fraud schemes involving approximately $223 million in false billings.
Additionally, the Report highlights OIG studies that identify opportunities to reduce waste in Medicare. In FY 2013, the OIG found that Medicare could have saved almost a billion dollars annually if it had reimbursed for laboratory tests at the lower rates paid by the Federal Employees Health Benefits Program plans or state Medicaid programs. The OIG also found that Medicare could have saved up to $600 million by implementing a payment policy for early discharges from hospitals to hospice care consistent with Medicare payment policies for such discharges from hospitals to other clinical settings.
The OIG’s Fall 2013 Semiannual Report to Congress is available at:
Department of Health and Human Services Office of Inspector General. “Fall 2013 Semiannual Report to Congress.” 23 Dec. 2013.