HHS-OIG touts investigations of fraud, but says resources are limited

Cases of COVID-19 may be slowing down but general health care fraud is not, according to federal investigators.

The U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) published its semiannual report to Congress for the six months ending March 31. HHS is the federal government’s largest grant-making agency and fourth-largest contracting agency, responsible for more than $2.4 trillion in expenditures for more than 100 programs, Inspector General Christi A. Grimm said in her letter to Congress.

Christi A. Grimm
_{U.S. Department of Health and Human Services Office of Inspector General}

“As our work during this reporting period demonstrates, from protecting children to improving nursing home care to bolstering the integrity of managed care and more, HHS-OIG delivers positive results for the American people,” Grimm said.

The office has about two cents to oversee every $100 in spending, so it is limited by available resources, turning down up to 400 criminal and civil cases a year due to lack of resources, Grimm said.

“With current resources, HHS-OIG is unable to keep pace with these threats,” she said.

Phony diplomas

In January, HHS-OIG announced “Operation Nightingale,” an investigation with the U.S. Department of Justice (DOJ). Defendants in Florida allegedly sold more than 7,600 phony nursing degrees from April 2016 to October 2021.

The operation involved search warrants in at least five states. While it was unclear if any of the falsely credentialed nurses worked in primary care, DOJ said health care providers that hired them included a hospital in Georgia, U.S. Department of Veterans Affairs medical centers in Maryland and New York, skilled nursing care facilities in Ohio, New Jersey, New York, and Texas, a rehabilitation facility in New York, an assisted living facility in New Jersey, and home health facilities in Massachusetts and Texas.

Last month investigators announced five defendants pleaded guilty to wire fraud conspiracy for their roles in the scam. Each faces up to 20 years in prison.

Health care fraud

In January, a physician was sentenced to 20 years in prison for pleaded guilty to conspiracy to commit health care and wire fraud in Florida for allegedly billing more than $746 million and paying about $127 million for fraudulent urine drug tests and addiction treatments, according to HHS-OIG. He was ordered to surrender his medical license in that case.

The physician was serving as medical director or authorizing physician of more than 50 sober homes, substances use disorder treatment facilities, and clinical testing laboratories in the area of Palm Beach County, Florida, according to HHS-OIG.

In her report, Grimm called the cases involving the fraudulent nursing diplomas and the substance use disorder treatment “disturbing.”

Drug dealing doctor

Grimm’s report included examples involving prescription drugs and kickbacks.

In January, a physician in Michigan was sentenced to 16.5 years in prison for a scheme that resulted in fraudulent claims to Medicare, Medicaid, and other health insurance programs. Those claims were worth more than $250 million, and the physician illegally engaged in money laundering while distributing more than 6.6 million doses of medically unnecessary opioids, according to HHS-OIG.

Kickbacks

Regarding kickbacks, in November 2022, the company Modernizing Medicine Inc., an electronic health record vendor in Boca Raton, Florida, agreed to pay $45 million to resolve allegations it violated the federal False Claims Act. Among the allegations, the company paid health care providers to recommend the company and refer potential customers, according to HHS-OIG.

“HHS-OIG remains resolute in our commitment to aggressively combat fraud and hold wrongdoers accountable,” Grimm said in the report.