OIG Announces Record Setting Financial Recoveries Related to FY 2012 Enforcement Activities [11-30-12]

Filed under: Industry Updates — Editor @ 1:56 pm

On November 27, 2012, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released its Fiscal Year (“FY”) 2012 Semiannual Report to Congress (“Report”) for the second half of FY 2012. The Report describes some of the OIG’s major achievements related to the OIG’s enforcement, audit, evaluation and compliance work during the second half of FY 2012, as well as provides a summary of the results of the OIG activities throughout FY 2012. This article summarizes some of the key highlights from the Report. For a copy of the complete Report, click here.

Summary of OIG’s FY 2012 Financial Recoveries and Enforcement Activities

For FY 2012, the OIG reported expected recoveries of approximately $6.9 billion from the OIG’s investigative and audit activities, including $6 billion in investigative receivables and $924 million in audit receivables. This is up from the OIG’s expected audit and investigative recoveries of $5.2 billion in FY 2011, or an increase of more than 30%. In the Report, the OIG also identified approximately $8.5 billion of cost savings in FY 2012 as a result of legislative, regulatory or administrative actions that were supported by the OIG’s recommendations.

The OIG also reported 3,131 exclusions of individuals or entities from participation in federal health care programs, 778 criminal actions against individuals or entities that committed crimes against HHS programs and 367 civil actions, which include false claims and unjust enrichment actions filed in various federal district courts, administrative recoveries related to provider self-disclosures and civil monetary penalties settlements.

The OIG’s record number of financial recoveries in FY 2012 should signal to health care providers that enforcement of health care regulations is still on the rise. Although the OIG reported expected recoveries in FYI 2012 of approximately $6.9 billion, the OIG estimated that in FY 2011, there were $64 billion in improper payments from the Medicare and Medicaid programs. This suggests that the OIG is still only recovering about 10% of alleged improper Medicare and Medicaid payments. This gives the OIG a high incentive to continue its surge in enforcement activities and recover potential overpayments.

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