The OIG has issued their Semiannual Report to Congress for the period April 1, 2023 through September 30, 2023. The report highlights $3.44 billion in expected investigative and audit recoveries identified during the entirety of FY 2023. The report also details the OIG’s ongoing work through investigations and enforcement actions over the past 6 months which include:
- $82.7 million in recoveries from audits
- $2.26 billion in expected investigative recoveries
- 362 criminal actions
- 422 civil actions
- 750 excluded individuals
The types of issues identified that contributed to the $3.44 billion in expected recoveries include:
- COVID testing related schemes
- Opioid related fraud
- Improper risk adjustment coding
- Improper place of service (POS) reporting
- Improper billing of the following types of services:
- Psychotherapy services
- Advance care planning
- Genetic testing
- End Stage Renal Disease (ESRD) related services
- Durable Medical Equipment (DME)
- 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/semiannual/index.asp?hero=2023-fall-sar