Office of Inspector General (OIG) audit and investigative activity between Oct. 1, 2009 and March 31, 2010 resulted in expected recoveries amounting to approximately $3.1 billion, according to the agency’s Semiannual Report to Congress.

This dollar amount is considerably lower than the $20.97 billion the OIG said it expected to recover in its Semiannual Report to Congress for the period of April 1, 2009 through Sept. 30, 2009.

Also for this semiannual period, the OIG reports exclusions of 1,935 individuals and entities from participation in federal health care programs; 293 criminal actions against individuals or entities that engaged in crimes against departmental programs; and 164 civil actions.

Going forward, OIG officials have their work cut out for them, ensuring $165.4 billion in American Recovery and Reinvestment Act of 2009 (Recovery Act) funds the U.S. Department of Health and Human Services (HHS) began doling out last year are used appropriately.

OIG Inspector General Daniel R. Levinson acknowledges this daunting responsibility in the report saying that the OIG is developing plans for implementing new OIG mandates in the Patient Protection and Affordable Care Act and enforcement authorities and for issuing regulations.

“We are now transitioning to work that assesses the quality of data reported by recipients and the appropriate use of Recovery Act funds. OIG is also investigating allegations of fraud involving Recovery Act funds; overseeing and managing the exclusions program to prohibit excluded individuals and entities from participating in programs involving HHS Recovery Act funds; and coordinating with the Recovery Accountability and Transparency Board; the Government Accountability Office; and other oversight and law enforcement agencies at the Federal, State, and local levels,” Levinson says in the report.

Levinson said the OIG also will continue to participate in the Health Care Fraud Prevention & Enforcement Action Team (HEAT).

You can read all about the OIG’s recent audit and investigative activities in its Semiannual Report to Congress.

3 Responses to “OIG Activity Amounts to $3.1B in Expected Recoveries”

1. L Adams Says:
   July 7th, 2010 at 11:06 am

   Accoring to this new report, the OIG told congress it expected to collect $20.97 billion yet only collected $3.1 billion. This would lead me to speculate that, 1.) The OIG is inept at audit investigations; 2.) The OIG misrepresented it’s abilities to congress; or 3.) There isn’t as much fraud, waste and abuse out there as many in congress and in the administration believe. I’ll choose #3.

2. C. Proctor Says:
   July 7th, 2010 at 11:47 am

   I believe the OIG numbers are most likely affected by the recoveries of the RAC, CERT, HCC and other programs. This would better explain the difference in the projected numbers vs. what was actually collected. Although I do agree with L. Adams that there is not as much fraud, waste and abuse out there as once was anticipated. I definitely believe this to be a result of increased scrunity from the payer community, more providers are trying to become more compliant with their billing & coding practices.

3. Mary Says:
   July 23rd, 2010 at 7:27 am

   Fraud is definitely out there. Here’s just a few quick examples:

   http://www.cnn.com/2010/US/07/16/medicare.fraud/

   http://www.google.com/hostednews/ap/article/ALeqM5j7NTk7QrZsU8UXRRAIYWS51qG4FgD9H089G80

   http://www.stopmedicarefraud.gov/innews/texas.html

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