OIG Recoveries and Exclusions Rise in 2011

Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011.  The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations. 

For the fiscal year 2011, for example, the OIG reported expected recoveries of about $5.2 billion. This figure consisted of $627.8 million in expected audit recoveries and $4.6 billion in expected investigative recoveries. This number included $952 million in non-HHS investigative receivables resulting from the OIG’s work in areas such as the States’ share of Medicaid restitution.

The OIG also identified the estimated savings of early $20 billion as a result of legislative, regulatory, or administrative actions that were supported by its recommendations.

In 2011, the OIG excluded 2,662 individuals and entities from participation in Federal healthcare programs. Similarly, the Agency conducted 723 criminal actions against individuals or entities that engaged in crimes against HHS programs and pursued 382 civil actions, which included false claims and unjust-enrichment lawsuits, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters.

The OIG statistics reflect a strong agency commitment to detecting and preventing fraud, waste, and abuse, improving program inefficiencies, as well as ensuring that the providers meet program requirements.

If you have any questions about Medicare and Medicaid participation, exclusion, OIG or require other legal assistance, please contact us.