The Office of Inspector General (OIG) released its Semiannual Report to Congress detailing operations for the second half of the 2015 fiscal year. The Semiannual Report includes reporting on OIG Hotline Operations for 2015. The OIG Hotline Operations (OIG Hotline) fields tips and complaints from a range of sources about potential fraud, waste, abuse, and mismanagement in U.S. Department of Health and Human Services (HHS) programs. It is an essential avenue of communication with the public and considered a significant source of intelligence for the OIG.
The OIG Hotline was contacted 74,018 times during the first half the 2015 fiscal year and contacted another 64,372 times in the second half of the year. This means the OIG received over 138,000 calls, emails, letters, and other communications over the course of the 2015 fiscal year. Tips are received within the Office of Investigations (OI), where they are processed and analyzed. Then, the OI makes a determination of whether an issue rises to the level of a complaint under the OIG’s jurisdiction. Roughly five percent of hotline calls and correspondence result in complaint referrals to either an OIG field office, an appropriate HHS staff division or operating division (e.g., Centers for Medicare and Medicaid Services (CMS)), or another Federal agency for resolution.
The OIG forwarded approximately one-third of the complaints to their field offices for follow-up and slightly less than half to CMS, with the balance referred to other HHS operating divisions and Federal agencies. For issues that fall outside the OIG’s jurisdiction or that do not rise to the level of a complaint, the OIG provides individuals with other avenues to seek assistance, such as calling their state health and human services agencies or 1-800-MEDICARE. For example, if callers inquire about terminology on a Medicare Summary Notice, they will be referred to call 1-800-MEDICARE. If callers have complaints involving Medicaid eligibility, the caller is referred to call their State Medicaid agencies. In contrast, if a caller alleges that a Medicare beneficiary was billed for services not received, it is logged as a complaint.
It should be noted that CMS staff in central and regional offices, as well as staff at Medicare claims processing contractors, process complaints referred by the OIG. These staff members use an information system to assign, research, and resolve OIG-referred complaints. The database includes each complaint’s unique identifier, date of intake by the OIG, date of entry into CMS’ information system, date of the complaint’s assignment to a CMS regional office and to a claims processing contractor, closure date, and resolution code (if applicable).Subscribe to blog