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From Health Law Daily, June 02, 2017

Semiannual OIG report points to enforcement successes and payment reviews

By Bryant Storm, J.D.

HHS Office of Inspector General (OIG) enforcement efforts led to the filing of charges against 49 individuals or entities, 152 criminal actions, and more than $266.8 million in investigative receivables over the period from October 1, 2016 through March31, 2017, according to the agency’s semiannual congressional report. The semiannual report summarizes the agency’s activities over a six-month period and describes past actions as well as future priorities with regard to care quality, program efficiency, improper payments, enforcement activities, and fraud (OIG Report, June 2, 2017).

Report. The report describes OIG efforts to fulfill the four key goals of the agency’s strategic plan: (1) fight fraud, waste, and abuse; (2) promote quality, safety, and value; (3) secure HHS programs’ future; and (4) advance excellence and innovation. The semiannual report is designed to function as a summary of problems, abuses, and deficiencies identified within HHS program administration and operation.

Quality and efficiency. Regarding its efforts to enhance the safety and quality of care, the OIG pointed Congress to its investigations of Arizona nursing home deficiencies and Indian Health Services (HIS) hospitals. The report described OIG investigations of the early implementation of the Quality Payment Program (QPP), an effort to increase focus on the quality and value of care (see CMS’ QPP links Medicare payments to value, December 21, 2016). Additionally, the OIG discussed its investigations of states’ handling of prescription drug rebates from pharmaceutical manufacturers.

Payment. In fiscal year (FY) 2016, HHS estimated improper payments of more than $96 billion dollars. The OIG report examined efforts to combat that figure, including monitoring of: express lane eligibility (see Express lane eligibility is efficient but states still make errors, October 18, 2016), payments after the death of a beneficiary, payments for incarcerated beneficiaries, improper payments for chiropractic services (see Medicare’s payment error rate to chiropractors is an astonishing 82%, October 20, 2016), Home and Community-Based Services (HCBS) waiver program payments (see Four states claim $176.5M in unallowable HCBS waiver program costs, October 26, 2016), and payment for cochlear devices. During the six-month period, the OIG also reported on the two-midnight policy (see Two-midnight Medicare policy succeeding but still lacks full cooperation, December 19, 2016) and payments for Part D catastrophic coverage (see OIG study finds high-price drugs are jeopardizing future of Medicare Part D, January 6, 2017).

Fraud. During the first half of FY 2017, the OIG reported expected investigative recoveries of over $2.04 billion. Additionally, the OIG reported 468 criminal actions against individuals or entities that engaged in crimes against HHS programs, 461 civil actions, and 1,422 exclusions of individuals and entities from participation in the federal health care programs. Key areas of focus for enforcement efforts included prescription drugs, care in non-institutional settings, and grant fraud.

ACA. The OIG also participated in a number of congressional hearings over the six-month reporting period. Notable testimony included the testimony of Vicki L. Robinson, Senior Counselor for Policy, before the House Committee on Oversight and Government Reform: Subcommittee on Health Care, Benefits, and Administrative Rules regarding fraud, waste and abuse under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Other ACA oversight included reviews of the state-based and federal marketplaces.

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