Kusserow on Compliance: OIG reports decline in criminal actions and investigative receivables

The HHS Office of Inspector General (OIG) released its second Semiannual Report of 2015, which describes “significant problems, abuses, deficiencies, and investigative outcomes on the administration of HHS programs and operations that were disclosed during the reporting period” to Congress. This edition of the report explained the work completed during the second half of 2015, from April to September. This year, reported criminal actions and investigative accomplishments declined. The OIG offered no explanation for this

Background

The OIG is required by law to issue semi-annual reports to Congress regarding the results of their efforts. This newly-released second report for 2015 included a summary of accomplishments for the entire year

Receivables

Reported investigative accomplishments included expected recoveries of approximately $3.35 billion, consisting of nearly $1.13 billion in audit receivables and over $2.22 billion in investigative receivables, which includes over $286.6 million in non-HHS investigative receivables resulting from the agencies’ work in areas such as the states’ shares of Medicaid restitution. The OIG reported investigative receivables of $2.22 billion this year, which is a sharp decline annually since 2012, when it reported $6 billion in receivables. The following two years it reported $5 billion and $4.1 billion, respectfully.

Criminal actions

The OIG reported 925 criminal actions against individuals or entities that engaged in crimes against HHS programs. This is also a slight decline from the prior two years. However, there was an increase in civil actions to 682 civil actions this year. This civil action figure has been a steadily growing number over the last five years. These actions include false claims and unjust enrichment lawsuits filed in federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters. The OIG also reported exclusions of 4,112 individuals and entities from participation in federal health care programs, which is a slight increase over the 4,017 exclusions reported in 2014.

The Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint effort by the OIG and the Department of Justice (DOJ) to invest in new resources and technologies aimed at preventing and combating health care fraud, waste, and abuse, reported 225 criminal actions this year. This too represents declining statistical results over the last three years.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2015 Strategic Management Services, LLC. Published with permission.