Insights & Resources

Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023.  Similar to other timely client alerts about OIG’s recently issued Top Management Challenges document and its Health Care Fraud and Abuse Control Report, the SAR contains important “nuggets” for providers that give crucial insights into those areas on which OIG will focus in the year ahead such as:
 

• Analyzing providers’ use of emerging, evolving, or new technologies to ensure that it does not become a vehicle for widespread fraud;

 

• Reviewing claims for genetic and other laboratory tests, especially those that have an indicia of being procured through the payment of kickbacks and bribes;

 

• Rooting out schemes involving manipulation of managed care programs that maximize Medicare and Medicaid payments to insurance plan sponsors and minimize care to enrollees;

 

• Ensuring that nursing homes prioritize quality of care and quality of life for residents;

 

• Preventing prescription drug misuse and strengthening care for substance use disorders; and

 

• Pursuing providers who submit claims for reimbursement to Medicare or Medicaid for services that are not rendered or that are medically unnecessary.

 
With OIG projecting monetary recoveries into the millions during this reporting period alone (April 1 and September 30, 2023), it is clear that OIG remains very active in its investigation and oversight of HHS programs.  Providers would be well-served, therefore, to perform a year-end evaluation that identifies their specific risk areas, assesses the effectiveness of their compliance programs, and makes necessary adjustments for 2024.   
 
A copy of the complete Semiannual Report can be found at: https://oig.hhs.gov/reports-and-publications/archives/semiannual/2023/fall-sar-2023.pdf.
 
Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.