Office of Inspector General (OIG) Publishes Semiannual Report

 The information below provides a short synopsis of the report.  To obtain the full report – choose the link at the end of this brief.

 Summary of Fiscal Year 2012 Accomplishments

 For FY 2012, the OIG reported expected recoveries of about $6.9 billion consisting of $923.8 million in audit receivables and $6 billion in investigative receivables (which includes $1.7 billion in non-HHS investigative receivables resulting from work in areas such as the States’ shares of Medicaid restitution). They also identified about $8.5 billion in savings estimated for FY 2012 as a result of legislative, regulatory, or administrative actions that were supported by their recommendations. Such savings generally reflect third-party estimates (such as those by the Congressional Budget Office) of funds made available for better use through reductions in Federal spending.

 FY 2012 exclusions were reported of 3,131 individuals and entities from participation in Federal health care programs; 778 criminal actions against individuals or entities that engaged in crimes against HHS programs; and 367 civil actions, which include false claims and unjust-enrichment lawsuits filed in Federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters.

 Medicare Strike Force Teams

 Medicare Fraud Strike Force teams coordinate law enforcement operations conducted jointly by Federal, State, and local law enforcement entities. The teams, now a key component of HEAT (Health Care Fraud Prevention and Enforcement Action Team), have a record of successfully analyzing data to quickly identify and prosecute fraud. The Strike Force began in March 2007 and is operating in nine major cities. 

 The effectiveness of the Strike Force model is enhanced by interagency collaboration. For example, we refer credible allegations of fraud to the Centers for Medicare & Medicaid Services (CMS) so that it can suspend payments to the perpetrators. During Strike Force operations, OIG and CMS work to impose payment suspensions that immediately prevent losses from claims submitted by Strike Force targets.

 * Strike Force Accomplishments -During FY 2012, Strike Force efforts resulted in the filing of charges against 305 individuals or entities, 181 convictions, and $151 million in investigative receivables.

 * Nationwide Takedown -On May 2, 2012, over 200 OIG Special Agents, Forensic Examiners and Analysts participated in Medicare Fraud Strike Force operations in 7 cities that resulted in charges against 107 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing. The coordinated takedown involved the highest amount of Medicare false billings in a single takedown by the HEAT strike force.

 Full report is here