It would be easy to dismiss the U.S. Department of Health and Human Services (HHS), Office of Inspector General’s (OIG) recently issued Semiannual Report (Report) as yet another in the long line of publications that tout big wins and persistent challenges in the OIG’s efforts to combat health care fraud, waste, and abuse during the reporting period (April 1 to September 30, 2025). After all, the Report addresses themes common to most OIG publications, including the need to strengthen fiscal integrity, protect patients from harm, address public health crises related to substance use disorder and behavioral health, and promote excellence in departmental programs.
This Report is noteworthy, however, because it is the first report issued under the new Inspector General (I.G.), T. March Bell. While it is too early to make predictions about the priorities on which I.G. Bell will focus, it would be a mistake for providers and other stakeholders to become complacent with their compliance efforts and obligations in 2026.
The Report highlights the OIG’s reliance on “advanced analytical tools and the collaborative skills of its innovative, multidisciplinary workforce” to identify, prioritize, and mitigate risks such as:
- items or services with low barriers to entry where reimbursement exceeds acquisition costs such as with the application of skin substitute products in non-institutional settings and the use of remote patient monitoring;
- fraud schemes perpetrated by providers, manufacturers, distributors, or marketers of durable medical equipment, diagnostic testing, telemedicine services, and wound care; and
- improper payments in connection with the Provider Relief Fund, applied behavioral analysis services, evaluation and management services billed with modifier 25, and personal care assistant services.
The OIG also expressed concern that hospitals are not identifying, investigating, or reporting patient harm events, thereby limiting transparency and accountability for such harms. The OIG further challenged intermediate care facilities for individuals with intellectual disabilities to ensure that they have effective policies and procedures for safe evacuations, as well as staff and client tracking during emergencies. Lastly, the OIG reiterated its focus on promoting nursing home quality of care by addressing grossly substandard care, reducing falls among residents, and ensuring that staff are appropriately vetted and credentialed.
Given the sheer volume of the 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 start the new year by identifying their specific risk areas, assessing the effectiveness of their compliance programs, and making necessary adjustments for the year ahead.
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].
