The OIG issued their Semiannual Report to Congress this week.  The report details their ongoing investigations and enforcement efforts related to healthcare fraud and abuse for the period April 1, 2018 to September 30, 2018.  The OIG’s strong partnerships with the Department of Justice, Medicaid Fraud Control Units, and other Federal, State and local agencies are key and have again produced significant results, including:

• $2.91 billion in expected investigative recoveries
• 764 criminal actions
• 2,712 excluded individuals/entities
• 813 civil actions against individuals/entities

The Report identifies the specific types of services related to the fraud recoveries.  The services identified within the most recent report have all been identified in prior Semiannual Reports and include:

• Diagnostic radiology and laboratory testing
• Home health agencies and personal care services
• Ambulance transportation services
• Durable medical equipment
• Controlled and non-controlled prescription drugs

The OIG will continue their investigation and enforcement efforts to prevent healthcare fraud and abuse.  We recommend reviewing the Semiannual Report along with other government and payor reports as well as fraud alerts to identify known risk areas that are applicable to your organization.  We also recommend conducting audits related to your identified risks, particularly of those services which have been repeatedly associated with high instances of fraud and abuse.

The complete OIG Semiannual Report can be found here: https://oig.hhs.gov/reports-and-publications/archives/semiannual/2018/2018-fall-sar.pdf