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FY 2019 HHS Budget Request in Brief

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently submitted its budget request for fiscal year (FY) 2019. The OIG requested a total of $387.5 million to provide oversight for HHS programs, including law enforcement activities coordinated with the Department of Justice (DOJ). The proposed budget consists of $307.5 million for Medicare and Medicaid programs oversight including Health Care Fraud and Abuse (HCFAC) Program activities. The FY 2019 request is $23.7 million more than the FY 2018 request. The OIG also requested $80 million for oversight of HHS’s Public Health and Human Services (PHHS) programs.

The FY 2019 PHHS program activities will include the OIG’s focus on implementing new HHS authorities under the 21st Century Cures Act in FY 2019. The 21st Century Cures Act provides $1 billion in new grants for prevention and treatment of opioid addiction. A new civil monetary penalty (CMP) authority has also been implemented for fraud involving HHS grants and contracts. The OIG will also use data, technology, and specialized expertise to strengthen PHHS program oversight, Medicare Advantage oversight, and Medicaid program integrity.

The OIG’s budget request also includes enforcement action data to demonstrate the OIG’s accomplishments. In FY 2017, 3,244 individuals and organizations were excluded from participation in federal health care programs. Among those exclusions, 1,281 were related to Medicare or Medicaid criminal convictions. Other health care programs accounted for 309 exclusions, while patient abuse and neglect accounted for 266 exclusions, and licensure revocations accounted for an additional 973 exclusions. The OIG also issued 243 audits and evaluations with 682 recommendations that would correct program vulnerabilities and save program funds.

OIG HHS Budget Increase Justification for 2019

The OIG included a summary of its Semiannual Report to Congress in its budget request. The Fall 2017 Semiannual Report stated that 881 criminal actions and 826 civil and administrative enforcement actions were filed in federal court. These included False Claims Act lawsuits and Civil Monetary Penalty (CMP) law settlements. The OIG also concluded cases involving approximately $49.1 million in CMPs for FY 2017. OIG industry outreach, guidance activities, and HHS recommendations also contributed to fraud and abuse prevention efforts.

The agency’s budget request further highlighted program integrity activities that resulted in savings, to justify the increased budget request for FY 2019. For example, the OIG is a major participant of the HCFAC Program, which returned five dollars to the Medicare Trust Funds for every one dollar invested in FY 2016. The OIG also anticipated that FY 2017 health care audits and investigations would return $4.7 billion to federal health care programs, yielding a $14 to $1 return on investment. Approximately $49.1 million of that $4.7 billion will come from CMPs imposed in enforcement actions. The OIG attributed an additional $24.4 billion in cost savings from recommended policy changes based on Congressional Budget Office and HHS actuaries’ estimates.

The full HHS OIG report is available at: https://oig.hhs.gov/reports-and-publications/archives/budget/files/2019budget.pdf.

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