Kusserow on Compliance: OIG estimates $4.4B in savings in 2017

The HHS Office of Inspector General (OIG) issued its second Semiannual Report to Congress for 2017 summarizing achievements for the year that included estimated savings of $4.4 billion as result of its work.   It reported over $4 billion in “investigative” receivables for the full year from expected recoveries from criminal actions, civil and administrative settlements, civil judgments, and administrative actions by OIG. In addition, it reported almost $300 million in audit findings. For the year, the OIG brought criminal actions against 881 individuals or organizations, and 826 civil actions, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. The OIG cited some of the major fraud enforcement actions for the year that included the largest national health care fraud takedown in history, involving more than 400 defendants in 41 federal districts and $1.3 billion in false billings to Medicare and Medicaid.

The largest body of work involves investigating matters related to the Medicare and Medicaid programs, such as patient harm; billing for services not rendered, medically unnecessary services, or services more extensive than those actually provided; illegal billing, sale, diversion, and off-label marketing of prescription drugs; and solicitation and receipt of kickbacks, including illegal payments to patients for involvement in fraud schemes and illegal referral arrangements between physicians and medical companies. The OIG also investigates cases involving organized criminal activity, medical identity theft, and fraudulent medical schemes that are established for the sole purpose of stealing Medicare dollars. Those who participate in these schemes may face heavy fines, jail time, and exclusion from participating in Federal health care programs. The OIG highlighted some of the most common criminal fraud scheme case types relating to (1) controlled and non-controlled prescription drugs, (2) home health agencies and personal care services, (3) ambulance transportation, (4) DME, and (5) diagnostic radiology and laboratory testing.

Highlighted major cases include actions taken against 120 opioid-related defendants, including 27 doctors. In addition, the OIG issued 295 exclusion notices related to the use and abuse of controlled substances. Other high profile OIG actions related to fraud allegations noted were against Mylan Inc. that agreed to pay $465 million; and eClinicalWorks, LLC (ECW) for $155 million.

 

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 © 2017 Strategic Management Services, LLC. Published with permission.