Wednesday, June 4, 2014

OIG Releases Semiannual Report to Congress

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has released its Semiannual Report to Congress, which summarizes OIG activities for the 6-month period ending March 31, 2014. During this reporting period, OIG ramped up its oversight efforts to implement the Affordable Care Act (ACA); ensured the appropriate use of prescription drugs by Medicare and Medicaid beneficiaries; and identified vulnerabilities in, and recommendations for improving, the Centers for Medicare & Medicaid Services’ (CMS) oversight of contractors that administer more than a half trillion dollars in benefits each year.

The report specifically highlights the first half of FY 2014, and OIG’s expectation of more than $3.1 billion in recoveries consisting of nearly $295 million in audit receivables and about $2.83 billion in investigative receivables, which include about $813.7 million in non-HHS investigative receivables resulting from OIG work in areas such as the States’ shares of Medicaid restitution. Further, OIG reports 465 criminal actions against individuals or entities that engaged in crimes against HHS programs; and 266 civil actions, which include False Claims Act (FCA) and unjust-enrichments lawsuits filed in federal district court, Civil Monetary Penalties (CMP) settlements and administrative recoveries related to provider self-disclosure maters.

OIG also reported exclusions of 1,720 individuals and entities from participation in Federal health care programs. Specific to nursing facility (NF) centers, OIG notes two previously released reports (Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries and Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring); as well as the OIG settlement with Ensign, who agreed to pay $48 million to resolve civil allegations under the FCA that it knowingly submitted false claims to Medicare for rehabilitation therapy services at six of its SNFs. To obtain a complete copy of the report go to

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