money 7881948 640

OIG Recovers More Than $200.1 Million In Oversight Efforts

07 Jun, 2023 F.J. Thomas

money 7881948 640
                               

Sarasota, FL (WorkersCompensation.com) – The Office Of Inspector General (OIG) has been quite busy this past year, according their most recent HHS-OIG Semiannual Report to Congress.

Accountable to Congress, the OIG is comprised of several different compartments, including the Office Of Audit Services, the Office of Evaluation and Inspections(OEI), the Office of Investigations (OI), the Office of Counsel to the Inspector General (OCIG), and Mission Support and Infrastructure (MSI). Spanning a 6-month reporting period, from Oct. 1, 2022, through March of this year, the report summarizes the OIG’s reviews and work that identifies risks and deficiencies, as well as abuses, problems, and investigative outcomes related to federal programs.

According to the report, the OIG conducted 62 audit reports, and 19 evaluation reports. Those reviews resulted in $200.1 million in expected recoveries, as well as $277.2 million in questioned costs.

dditionally, the OIG made 213 new audit and evaluation recommendations related to the Department of Health and Human Services (HHS) that could potentially result in even greater recoveries. HHS also implemented 253 prior recommendations that were made as a result of OIG reviews.

In partnership with the Department Of Justice, along with other agencies such as Medicaid Fraud Control Units (MFCUs), as well as Federal and State law enforcement, the OIG’s work led to $892.3 million in recoveries expected from criminal investigations, and 345 criminal actions. The OIG took civil action against 324 defendants and entities. An additional new 1,365 individuals and entities were added to the Exclusions List, which excludes them from participating in any way in Federal Health Care programs.

The OIG also took a deep dive into COVID-19 federal programs. In the course of their review, the OIG reviewed processes related to COVID-19 risk and management, but also discovered a large amount of criminal activity. Some of the examples included issuance of fake vaccination cards, medically unnecessary lab testing related to COVID-19, and more.

Drug spending was another item that received close review. The OIG did a comparison of average sale pricing and average manufacturer pricing, and reviewed the methods of calculations used to determine pricing. In those investigations, the OIG determined that more guidance is needed in order to ensure consistent pricing.

The OIG also conducted quite an extensive audit on claims for Medicare Advantage plans, with a thorough review of adjustment codes that should identify whether a claim was actually denied or not. In the course of their review, the OIG determined that the lack of consistency and completeness in the use of adjustment codes was a hindrance to accuracy and oversight. Additionally, the OIG found errors in physician billing, including improper use of modifiers, and use of diagnosis codes not fully supported by clinical dictation.

The full 100-page report is available on the OIG Website.


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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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