Kusserow’s Corner: OIG Reports Investigative Accomplishments

The Office of Inspector General (OIG) released its Spring 2013 Semiannual Report to Congress covering the period October 1, 2012 to March 31, 2013.  The summary of the OIG accomplishments included expected recoveries of about $3.28 billion in investigative receivable that includes $642.3 million share of Medicaid restitution at the state level. The report also notes the exclusion of 1,661 individuals and entities that are being added to the OIG List of Excluded Individuals and Entities (LEIE).  Of this number, 484 were criminal actions involving crimes against HHS programs, and 240 were civil and civil monetary penalty (CMP) actions for false claims and unjust enrichment actions.

The OIG also reported results of the Medicare Fraud Strike Force that is operating in nine metropolitan areas.  It was established as part of Health Care Fraud Prevention and Enforcement Action Team (HEAT).  The OIG reported during this period the Strike Force’s activities resulted in the filing of charges against 148 individuals and entities, along with 139 criminal actions, and $193.7 million in Investigative Receivables.

One interesting note, not widely known, is that the OIG has a program to step up enforcement efforts by detailing full-time attorneys, some of whom are Special Agents, to US Attorney Offices to serve as Special Assistant US Attorneys to support prosecutions.  In many cases, the Medicare and Medicaid expertise of the OIG supplements the prosecutors in specialized areas of health care.

Richard Kusserow served as the DHHS Inspector General for 11 years, with prior services in the FBI.  He is currently CEO of Strategic Management Services.

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.