Yesterday, the Office of Inspector General (OIG) issued their Semiannual Report to Congress which estimates nearly $5.9 BILLION in expected recoveries and savings. The Report details enforcement actions during the period April 1, 2019 through September 30, 2019 which include:
- $819 million in recoveries from audits
- $5.04 billion in investigative recoveries
- 809 criminal actions
- 695 civil actions
- 2,640 excluded individuals and entities
The Semiannual Report highlights the specific types of services included in the recoveries, many of which, are currently included in the OIG Work Plan.
- Billing for medically unnecessary services and services not rendered
- Telemedicine services
- Opioid prescription abuse
- Genetic testing
- Cardiac stent procedures
- DME services
- Inpatient rehabilitation services
- Skilled nursing care services
- Hospice and Home Health services
We recommend you read the complete Semiannual Report to identify risk areas that are pertinent to your organization. High risk services identified within the Semiannual Report and Work Plan should be incorporated in to your auditing and monitoring efforts. HBE’s team of experts is available to assist you with conducting risk assessments, routine auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.
The entire OIG Semiannual Report can be accessed here:https://oig.hhs.gov/reports-and-publications/archives/semiannual/2019/2019-fall-sar.pdf