Healthcare compliance enforcement is “full steam ahead”

June 10, 2018

The American Health Laywers Association reports that the Department of Health and Human Services Office of Inspector General (OIG) expects investigative recoveries of $1.46 billion for the first half of fiscal year (FY) 2018, the agency said in its semiannual report to Congress.

Last year at this time, OIG reported more than $2.04 billion in expected recoveries for the first half of FY 2017. The latest report covers October 1, 2017 through March 31, 2018.

According to the report, during the first six months of FY 2018, OIG initiated criminal actions against 424 individuals or entities and civil actions against 349 individuals or entities. In addition, OIG excluded 1,588 individuals and entities from federal health care programs.

Inspector General Daniel R. Levinson emphasized OIG’s reliance on “data-driven decision making” in its efforts to curb fraud, waste, and abuse in federal health care.

Levinson flagged prescription drug fraud—including opioids, drug diversion, pill mills, and medical identity thefts—and cybersecurity risks as leading areas of focus for OIG.

The report highlighted two “significant enforcement accomplishments” during the reporting period—a Miami home health agency fraud scheme that resulted in a six-year sentence for the agency’s owner and a $45 million restitution order; and United Therapeutics Corporation’s $210 million settlement of kickback allegations that it used a foundation as a conduit to pay the copayments of Medicare patients taking its drugs.

OIG also reported expected recoveries of $187.5 million and $1.5 billion in potential savings related to its oversight work, including findings of improper claims for managed long term care and improper electronic records incentive payments.

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