Enforcement Action Update: 2022 Fall Semi-Annual Report to Congress Issued by OIG

December 22, 2022

By Porzio Life Sciences

According to the Inspector General Act of 1978 (Public Law 95-452), as amended, the Inspector General is required to report semiannually to the head of the Department and to Congress on the activities of the office during a 6-month period.  On December 7, 2022, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its Fall 2022 Semiannual Report to Congress. The report highlights the period April 1, 2022, through September 30, 2022, where its findings from audits and evaluations are intended to "help construct actionable strategies that will yield meaningful improvements."  As stated in the report, investigative and audit recoveries are expected to reach nearly $4 billion during FY 2022, including $62.9 million from audits and $1.29 billion from expective recoveries from investigations.  One section of the report highlights OIG accomplishments in an “At-a-Glance Highlights” table.  

OIG identifies some of the following areas that resulted in the expected recoveries: 

•    COVID testing-related schemes
•    Opioid-related fraud
•    Improper risk adjustment coding 
•    Prescribing medically unnecessary items/services
•    Improper billing for services, including critical care services, durable medical equipment, critical access hospitals, home health, and hospice.

The 122-page report also includes multiple appendices such as the following that provide information related to OIG savings decisions supported by its recommendations, other peer OIG review results, reporting requirements of the Inspector General Act, and proposals for new and modified safe harbors regarding the Anti-Kickback Statute.  

Other OIG publications include the HHS-OIG Strategic Plan and OIG Work Plan.  The Strategic Plan has three key goals: (1) to fight fraud, waste, and abuse; (2) to promote quality, safety, and value in HHS programs and for HHS beneficiaries; and (3) to advance excellence and innovation. The Work Plan identifies projects OIG plans to undertake during the fiscal year (FY) involving various HHS operating divisions and agencies.   

OIG recommends that organizations review the Semi-annual report to identify areas of risk that should be evaluated as part of the compliance program assessment. 

A copy of the Report can be found here. 

For more information regarding HHS-OIG enforcement, please see the Government Prosecutions section of the Enforcement Actions Database. 

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