Healthcare News & Insights

Banner year: OIG Audits and investigations net $6.9M

Sure, your hospital may be struggling financially to make ends meet in this era of providing quality care for less, but the Department of Health & Human Services (HHS) Office of Inspector General (OIG) isn’t suffering along with you. Instead it’s having a record breaking year thanks to its audits and investigations.

In the OIG’s semiannual report to Congress, the government agency revealed that it expects to recover about $6.9 billion.

The breakdown of the recoveries includes $923.8 million in audit receivables and $6 billion in investigative receivables. The OIG also reported an estimated savings of $8.5 billion resulting from legislative, regulatory or administrative actions.

“OIG has been at the forefront of fighting waste, fraud and abuse in Medicare, Medicaid and more than 300 other HHS programs for more than 30 years,” said Inspector General Daniel Levinson in a press release. “We’ve made significant progress over the past year with the help of a dedicated, professional staff and the collaborative efforts of our government partners. In the coming months, we’ll continue our work protecting the integrity of HHS programs and the health and welfare of the people they serve.”

So in other words, the audits and investigations are just going to keep coming, and will probably increase in the coming year.

Additional findings

The OIG also reported excluding 3,131 individuals and entities from participation in federal healthcare programs in fiscal year 2012, and brought 778 criminal actions again individuals or entities that engaged in alleged crimes against HHS programs.

Civil actions numbered 367 and included false claims and unjust enrichment lawsuits, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

In regards to Medicare, the Medicare Fraud Strike Force filed charges against 305 individuals or entities. It had 181 convictions and garnered $151 million in investigative receivables.

2012 also saw the OIG’s largest ever single takedown for Medicare false billings — $452 million in false claims. The fraud schemes resulted in charges against 107 people, which included physicians, nurses and other licensed medical professionals.

So if ever there was a time to create teams to handle audits at your facility, it’s now’s. A team trained specifically to handle audits does it more effectively and efficiently — meaning it can win back more money for your hospital.

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