Written by Stephanie D. Willis
The OIG’s 2011 Fall Semiannual Report describes the actions the agency undertook between April 1 and September 30, 2011 and summarizes its Medicare and Medicaid claims reviews and its legal, investigative, and monitoring activities. These monitoring activities now employ the enhanced “data mining, predictive analytics, trend evaluation, and modeling” technology discussed in prior posts about the OIG 2012 Work Plan, which strengthen the OIG’s ability to pursue conduct that it views as violating health care fraud, waste, and abuse laws.
In line with its increased focus on monitoring and fraud, waste, and abuse detection, the OIG’s Semiannual Report highlights the success of the agency’s enforcement efforts and pays special attention to the $272,500 in stipulated penalties imposed on two companies that the OIG found to be out of compliance with their obligations under Corporate Integrity Agreements (CIAs). Stipulated penalties are monetary penalties for violations of specific conditions described in an entity's CIA with the OIG, e.g., failing to appoint a Compliance Officer or not notifying the OIG of other government investigations and legal proceedings against the entity. The placement of the stipulated penalties in Inspector General Daniel Levinson's message preceding the actual report evidences the OIG's plan to push its enforcement agenda beyond the signing of a settlement agreement and into CIA compliance monitoring.
Other investigative results for FY 2011 include:
- expected recoveries of about $5.2 billion ($627.8 million in audit receivables and $4.6 billion in investigative receivables);
- approximately $19.8 billion in savings based on Congressional Budget Office estimates for FY 2011 as a result of legislative, regulatory, or administrative actions that were supported by OIG recommendations;
- exclusions of 2,662 individuals and entities from participation in Federal health care programs;
- 723 criminal actions against individuals or entities that engaged in crimes against HHS programs; and
- 382 civil actions, including false claims and unjust-enrichment lawsuits, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.
According to Hope Foster, Chair of Mintz’s Health Care Enforcement Defense Group, “this report reminds health care providers that the OIG is an active player in the federal government’s enforcement of its fraud, waste, and abuse authorities and is using all of its tools; it provides important information about what the OIG is doing and is a must-read for all who are reimbursed by Medicare or Medicaid.”