In its semiannual report to Congress, the House of Human Services and Office of Inspector General (HHS-OIG) announced that its audits and investigations would likely yield about $3 billion in recoveries. The report covers 320 criminal enforcement actions between October 1, 2021, to March 31, 2022, against entities and individuals who committed crimes that impacted the HHS’s programs. The HHS-OIG also reported 320 civil actions — most of these involve unjust enrichment schemes and false claims filed in Federal District Court, financial penalty settlements and self-reported disclosure matters. The agency excluded another 1043 entities and individuals from participating in Federal health care programs.
Other numbers that are worth noting:
Some good news about telehealth: The OIG found that 84% of Medicare beneficiaries used telehealth services with providers they already had relationships with.
COVID-19 testing drove spending: Medicare Part B spent $1.5 billion on laboratory tests, while non-COVID test spending went down by $1.2 billion.
Half the states failed to meet their nursing home oversight targets: Surveys found that 84% did not meet performance measures for at least three years. Those who failed were supposed to submit action plans for addressing the issues, but 10% of those plans were missing, and countless others lacked substantive information.
Many diagnosed opioid addicts not properly treated: About 1 million Medicare recipients with diagnosed opioid use disorders did not receive medication that would help with their disorder, and only half of those treated with medication also got behavioral therapy. The worst states were Florida, Kansas, Nevada, and Texas. It also found that beneficiaries of color were less likely to receive treatment or therapy than white beneficiaries.
Help available to those with information
While there were some bright spots, it is clear the HHS-OIG still has much work to do. Whistleblowers willing to step forward and knowledgeably discuss these matters with the HHS-OIG may first wish to contact an attorney who represents clients in similar situations. These legal professionals can guide clients through the process and advocate for awards for their client’s bravery.