The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 4, 2024. This SAR comes on the heels of OIG’s recently issued Top Management & Performance Challenges document. Read our previous alert here. These documents, especially when read together, give providers vital insights into how OIG identifies and prioritizes its most significant activities, as well as the critical issues on which it will focus in the year ahead.
During the reporting period (April 1 – September 30, 2024), OIG touted its “risk-based approach”, “sophisticated data analytics”, and “modern investigative techniques” to identify, prioritize, and mitigate risks such as:
- Medically unnecessary durable medical equipment (DME), including providers who prescribe off-the-shelf orthotic braces via telehealth;
- Inadequate medical records documentation in opioid treatment programs related to admissions, treatment plans/assessments, prescription monitoring, drug screening results, and counseling services;
- Improper use of COVID-19 funds, including for personal enrichment and as a vehicle for illegal kickbacks between pharmacies or DME suppliers and providers; and
- Provision of medically unnecessary or unskilled services at skilled nursing facilities, including billing for services not rendered, and improperly billing telehealth such as originating site facility fees.
OIG also signaled its intention to continue oversight activities related to non-compliance with the Two-Midnight Rule, remote patient monitoring, nursing home quality of care and patient safety, genetic testing, amniotic wound graft, and mechanical ventilation billing, and misuse of HHS grant funds. The SAR also reflects OIG’s growing use of its exclusion authorities to rid Federal health care programs of alleged bad actors, with over 3,200 individuals or entities excluded year-to-date (i.e., roughly 291 exclusions per month).
Given the sheer volume of OIG’s oversight and investigative activities, and its increasingly refined strategies to root out fraud, waste, and abuse in HHS programs, providers would be well-served to perform a year-end evaluation that identifies their specific risk areas, assesses the effectiveness of their compliance programs, and makes necessary adjustments for 2025.
A copy of the complete Semiannual Report is available here.
Should you have any questions regarding the above or would like guidance on strengthening your existing compliance efforts, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].