The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released its Fiscal Year (FY) 2020 budget justification. The OIG requests a $403.2 million budget for FY 2020, which is a $22.5 million increase from the FY 2019 Enacted Budget. The OIG did not estimate for sequestration, which in the past has typically led to a $14 million reduction in the Office’s budget. The OIG’s budget is divided into two categories, the Public Health and Human Services (PHHS) oversight budget and the Medicare and Medicaid oversight (Health Care Fraud and Abuse Control (HCFAC) Program) budget. The OIG uses 23% of its resources for PHHS oversight, and is requesting $80 million for FY 2020, which is a decrease of $6.5 million from the FY 2019 Enacted Budget. The OIG uses 77% of its resources for HCFAC Program oversight, and is requesting $323.2 million for FY 2020, an increase of $29 million from FY 2019.
The FY 2020 PHHS program oversight will focus on:
- programs addressing opioid addiction and other substance abuse;
- serious mental illness;
- the health and safety of children in HHS programs;
- quality, safety, and program integrity in Indian Health Services (IHS) and American Indians and Alaska Natives health related programs;
- grants and contracts management; and
- emergency preparedness and response activities.
The OIG plans to strengthen PHHS programs by using data analytics, incorporating and using modern technology, leveraging specialized expertise, and forming strategic partnerships to focus on high-risk areas and increase effectiveness and outcomes of programs. The OIG will also focus on the integrity of PHHS grant programs and contract services, including using an enterprise wide data strategy to detect fraud and abuse.
In FY 2020 HCFAC oversight will continue to focus on enhancing and expanding activities to combat fraud, waste, and abuse in Medicare and Medicaid. HFCAC’s key oversight areas for the year will include:
- prescription drug abuse (including opioids);
- home and community-based services;
- cybersecurity and health information technology (including telehealth);
- prescription drug programs;
- managed care and value-based programs;
- improper payments;
- combating fraud; and
- strengthening program integrity (including provider enrollment and other integrity measures).
The OIG also requests additional funding for greater oversight for two specific areas, home health services and other community health settings, and Medicaid program oversight. OIG proposes an additional $10 million to specifically increase oversight of home and community health services provided to beneficiaries, ensure the integrity, quality, and safety of those services, and decrease fraud, waste, and abuse. The OIG proposes an additional $5 million to increase its ability to use data for Medicaid oversight purposes. It also wants to use the additional funds to enhance the effectiveness and efficiency of Medicaid Fraud Control Units, and audit the Medicaid drug rebate program.
Additionally, the OIG also summarized its Semiannual Reports to Congress and highlighted the Office’s FY 2018 accomplishments. For example, in FY 2018 OIG investigations resulted in 764 criminal actions and 813 civil actions. During the same year, OIG received $59.9 million from self-disclosure cases, imposed 2,712 program exclusions, enforced 3 Corporate Integrity Agreement (CIA) penalties, and imposed 213 civil monetary penalties resulting in $66.1 million. OIG was also involved in 332 False Claims Act settlement agreements resulting in $2.6 billion. Additionally, OIG entered into 55 CIAs in FY 2018.
The OIG also highlighted money regained from auditing and oversight activities, including $2 billion in questioned costs, $939.3 million in unauthorized financial assistance to health plan issuers, $180 million in unallowed Medicaid reimbursement for mental health services, and $823 million in funds that could be put to better use.
Overall, the OIG’s priority outcomes for FY 2019, include:
- Protect beneficiaries from opioid and prescription drug abuse;
- Promote patient safety and payment accuracy in home health and community settings;
- Ensure health and safety of children served by HHS grants; and
- Strengthen protections against Medicaid fraud and abuse.
The OIG’s FY 2020 Justification of Estimates is available at: https://oig.hhs.gov/reports-and-publications/archives/budget/files/2020budget.pdf