HHS Inspector General outlines enforcement actions for second half of fiscal year 2023

© U.S. Department of Health and Human Services

Audits and investigations of participants in federal health programs continued in the second half of fiscal year 2023, according to a new report from the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG).

Spring, summer and fall 2023 generated 65 audit reports and 22 evaluation reports identifying $82.7 million in expected recoveries and $1.2 billion in questioned costs, according to HHS-OIG.

Along with allegations of waste, fraud and abuse, HHS could save up to $47.2 million if the federal department implemented all of the OIG’s audit recommendations, said the “Semiannual Report to Congress” by Inspector General Christi A. Grimm. The report covered the six-month period ending Sept. 30, 2023.

“OIG continues to focus on the most significant and high-risk issues in health care and human services,” Grimm’s report said. “Our mission is to provide objective oversight to promote the economy, efficiency, effectiveness, and integrity of HHS programs, as well as the health and welfare of the people they serve.”

Christi A. Grimm
_{© U.S. Department of Health and Human Services}

The report also summarized work of the entire fiscal year 2023, projecting expected recoveries worth more than $3.44 billion from Oct. 1, 2022, to Sept. 30, 2023. HHS-OIG expects returns of more than $283 million from audit findings and $3.16 billion based on investigations.

There were 707 criminal enforcement actions against people and organizations suspected of crimes against HHS programs and the people they serve, the report said. There also were 746 civil actions and exclusions of 2,112 people and organizations from participating in federal health care programs, the report said.

Among the findings:

• Actions from the COVID-19 pandemic continue to spur federal enforcement action. There were 216 sampled enrollee days for psychotherapy services, in-person and via telehealth, and on 128 of them, providers did not meet Medicare requirements. Based on that review, it appeared providers received $580 million in payments that did not comply with Medicare requirements, including $348 million for telehealth and $232 million for in-person services.
• The U.S. Centers for Medicare & Medicaid Services did not accurately report on nursing home deficiencies identified during yearly and complaint inspections by state surveyors. Those included deficiencies involving health (34), fire safety (52), and emergency preparedness (two).
• The U.S. Food and Drug Administration (FDA) could take stronger enforcement action against tobacco retailers with histories of selling to underage buyers. FDA conducted more than 1 million inspections from 2010 to 2019, checking on 74% of retailers nationwide at least once. But “retailers with histories of violations were often not subject to the strongest enforcement actions,” the report said.
• HHS-OIG also published a report, “Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks,” to identify Medicare providers with high-risk billing for telehealth services. The report is intended to be a tool kit for state and federal investigators, along with private sector businesses, to assess potential risks within their own telehealth claims data.
• An estimated 1/3 of Medicaid enrollees with opioid use disorder (OUD) did not receive medication to treat it in 2021. Black enrollees, users aged 18 year and younger, and those with disabilities or blindness were less likely to receive the medications. HHS-OIG recommended states reduce barriers to treatment and work with federal partners to educate Medicaid enrollees about access to medications.