OIG Semiannual Report to Congress

The OIG has issued their Semiannual Report to Congress for the period October 1, 2021 through March 31, 2022.  The report highlights nearly $3 billion in expected investigative and audit recoveries identified during the first half of FY 2022. The report details the OIG’s ongoing work through investigations and enforcement actions which include:

  • $1.14 billion in recoveries from audits
  • $1.44 billion in expected investigative recoveries
  • 320 criminal actions
  • 320 civil actions
  • 1,043 excluded individuals

The types of issues identified that contributed to the nearly $3 billion in expected recoveries include:

  • COVID testing related schemes
  • Opioid related fraud
  • Improper risk adjustment coding
  • Improper billing of the following types of services:
    • Neurostimulator implants
    • Durable Medical Equipment (DME)
    • Facet-joint denervation
    • ESRD
    • Home health
    • Hospice
  • Prescribing medically unnecessary items/services

We recommend reviewing the Semiannual Report in its entirety to identify risks that are pertinent to your organization.  Identified areas of risk should be evaluated as part of your compliance program’s auditing and monitoring efforts.

The Semiannual report can be found here:  https://oig.hhs.gov/reports-and-publications/archives/semiannual/2022/2022-spring-sar.pdf

HBE’s team of experts is available to assist you with risk assessments, routine auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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