Office of Inspector General (OIG) investigations in 2009 resulted in $4 billion in health care fraud settlements and court-ordered returns, and this is just the “tip of the iceberg,” Inspector General Daniel R. Levinson said in his March 4 testimony before the subcommittee on Labor, Health and Human Services, Education, and related agencies of the House Committee on Appropriations.

“More disturbing,” said Levinson, “even if the rate of fraud remains constant, as health care expenditures continue to rise, the financial impact of health care fraud will continue to increase.”

To counter this trend, Levinson said the OIG will make the most of its proposed $272 million budget for 2011 to expand its activities in support of the joint Health and Human Services and Department of Justice (HHS-DOJ) Health Care Fraud Prevention and Enforcement Action Team (HEAT), including expanding the OIG-DOJ Medicare Fraud Strike Forces to 13 new locations.

Levinson said that the OIG also will continue to combat fraud using its “comprehensive strategy of prevention, detection, and enforcement” based on the following five principles:

1. Enrollment. Scrutinize individuals and entities that want to participate as providers and suppliers prior to their enrollment in the health care programs. Levinson said the OIG will continue to monitor the effectiveness of provider enrollment safeguards.
2. Payment. Establish payment methodologies that are reasonable and responsive to changes in the marketplace and medical practice. Levinson said the OIG has recommended cost-cutting measures, such as capping rental of oxygen concentrators at 13 months instead of 36 months.
3. Compliance. Assist health care providers and suppliers in adopting practices that promote compliance with program requirements. The OIG recommends providers and suppliers be required to adopt compliance programs as a condition of participating in the Medicare and Medicaid programs.
4. Oversight. Vigilantly monitor the programs for evidence of fraud, waste, and abuse.
5. Response. Respond swiftly to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities.

Levinson’s testimony goes on to tout the effectiveness of the Health Care Fraud and Abuse Control (HCFAC) program and its successes in cooperation with the HEAT program.

Read Inspector General Levinson’s full testimony.

3 Responses to “OIG Testimony Hints to 2011 Work Plan”

1. Mickie Kummer Says:
   March 17th, 2010 at 9:52 am

   If the OIG would respond swiftly to complaints of fraud and/or abuse reported by beneficiaries and provide feedback to the complainant, I believe the program would benefit.

   My father in law was in a nursing home for therapy following a hospital stay. He had to use a wheel chair during his stay. For months after he was discharged from the nursing home we received Medicare EOB’s showing payment being made for “rental” of the wheel chair. I called the nursing home and Medicare (the fraud number on the EOB) and nothing has been done about it. Medicare paid over a hundred dollars a month for “rental” of that wheel chair that my father in law did not have. I do not have the documentation with me at this time, but I believe they paid over $100.00 a month for the rental on that chair for a year. He was in the nursing home for about 3 weeks. If this happens often, which I am fairly confident it does, this type of thing has contributed to the Medicare and Medicaid programs financial woes. I for one do not want a Government sponsored and administered health care system.

2. Sherry Gann CPC Says:
   March 19th, 2010 at 7:47 am

   I would hope the OIG would make an effort to streamline the Credentialing Process with Insurace Carriers and not make it more difficult. As it stands now it is very difficult to hire a provider and get him credentialed with Managed Care Companies in a timely manner. The ability to accept new patients when not credentialed with Managed Care Companies makes it even more difficult to build a practice. I think they need to reduce the 180 time frame and require insurance companies to have sufficient staff to get the credentialing process done acuratley and in a more timely manner.

3. Dee Fulenwider Says:
   March 21st, 2010 at 10:04 am

   I too had a parent that I took care of the Medicare bills. When calling the Medicare fraud line about over billing procedures not performed nothing ever resulted. I refused to pay the bill and her account was turned over to collections. It is still there. If you are going to have the expense of a fraud and abuse phone number at least some action should take place. I have been in the medical field for over 20 years and if you find one rotten apple there is a whole peck somewhere in the group.

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