OIG Testifies on Health Care Fraud Investigation Results from the Past Three Years

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Deputy Inspector General, Gary Cantrell, testified before the U.S. Senate Special Committee on Aging about the highlights of the OIG’s enforcement activities. Many of his comments related to the current opioid crisis. Mr. Cantrell noted that the OIG Special Agents have full law enforcement power and collaborate with other federal, state, and local law enforcement partners to detect and prevent health care fraud, waste, and abuse. In the last three years, the OIG investigations have resulted in more than $10.8 billion in investigative receivables, including 2,650 criminal actions, 2,211 civil actions, and 10,991 program exclusions.

OIG and Medicare Fraud Strike Force Fight Health Care Fraud

In 2007, the Medicare Fraud Strike Force (Strike Force) began its efforts in Miami and then expanded operations to eight additional cities. The OIG acted as a lead participant with the Medicare Fraud Strike Force to utilize the resources of the OIG and Department of Justice, including Main Justice, U.S. Attorneys’ Offices, and the Federal Bureau of Investigation, as well as state and local law enforcement, to fight health care fraud in geographic hot spots. Since its inception, the Strike Force has charged more than 3,000 defendants who collectively billed the Medicare program more than $10.8 billion. Last year, the Strike Force led to the largest health care fraud enforcement action in history. That “takedown” resulted in 412 charged defendants across 41 federal districts, including 115 doctors, nurses, and other licensed medical professionals. The charges alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.

To maximize the OIG’s impact in its efforts to combat the opioid crisis, it collaborates with state Medicaid Fraud Control Units to detect and investigate fraud, waste, and abuse in state Medicaid programs. It also partners with the Healthcare Fraud Prevention Partnership and the National Healthcare Anti-Fraud Association in a public–private partnership to share data and information for the purpose of detecting and combating fraud and abuse in health care programs.

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The experts at Strategic Management Services have years of experience in assessing and improving compliance program effectiveness. If you would like to speak to one of our consultants about your program’s specific needs, you can contact us online or give us a call at (703) 683-9600.