Wednesday, June 3, 2015

OIG Semiannual Report

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its Semiannual Report to Congress, summarizing the activities of the agency for the 6-month period ending March 31, 2015. The report indicates that expected recoveries of over $1.8 billion consisting of nearly $544.7 million in audit receivables and about $1.26 billion in investigative receivables, which include about $142 million in non-HHS investigative receivables resulting from the States’ shares of Medicaid restitution.

OIG reported 486 criminal actions against individuals or entities that engaged in crimes against HHS programs and 326 civil actions, which 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. OIG also reported exclusions of 1,735 individuals and entities from participation in Federal health care programs. Headlines specifically mentioned in the “highlights” section include Hospices’ financial incentives to provide care in assisted living facilities, Critical access hospitals (CAH) – swing bed services payment rates (Medicare could have saved billions of dollars if CAH swing-bed services were reimbursed in skilled nursing facilities (SNFs); and Substandard and/or worthless skilled nursing services – Wisconsin.

To obtain a full copy of the OIG report go to

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