The OIG has issued their Semiannual Report to Congress for the period April 1, 2024 through September 30, 2024. The report highlights $7.13 billion in expected investigative and audit recoveries identified during the entirety of FY 2024. The report also details the OIG’s ongoing work through investigations and enforcement actions over the past 6 months which include:
- $4.36 billion in recoveries from audits and investigations
- 401 criminal actions
- 435 civil actions
- 1,439 excluded individuals
The types of issues identified that contributed to the $7.13 billion in expected recoveries are worth noting:
- Improper risk adjustment coding
- COVID related schemes
- Opioid related fraud
- Prescribing medically unnecessary services/items
- Improper billing of the following types of services:
- Mechanical ventilation
- Telemedicine
- Rehabilitation therapy services
- Durable medical equipment (DME), specifically braces
- Services not rendered/performed
We recommend reviewing the Semiannual Report in its entirety to identify risks that are pertinent to your organization. Identified risks should be evaluated as part of your compliance program’s auditing and monitoring efforts.
The HBE team of experts is available to assist you with risk assessments, utilization analysis, routine auditing and monitoring, as well as education and training for your clinical and administrative staff.
The OIG Fall Semiannual Report can be found here: https://oig.hhs.gov/documents/sar/10084/Fall_2024_SAR_508.pdf