OIG Expects to Recover Nearly $4B from Audits, Investigations in 2021

A blue door with two small holes in it.

The U.S. Department of Health and Human Services Office of the Inspector General’s fight against healthcare fraud, waste and abuse is paying off. The watchdog agency, in its Semiannual Report to Congress, noted that during the six-month period ended Sept. 30, 2021, it expects to make nearly $4 billion in recoveries as a result of audits and investigations conducted during fiscal year 2021.

The report projects that of the $4 billion, $787 million is expected to be recovered by the government based on audit findings, while another $3 billion is expected to be recovered based on investigations into fraud and abuse. That’s about on par with what the OIG reported it expected to recover in 2020. OIG said that it issued 87 audit reports and identified $318.91 million in potential savings for HHS as a result of its audit work.

As we wrote about in January, the OIG, in its monthly Workplan, noted that audits would be a top priority for the agency in 2021. Specifically, the OIG pointed to audits related to telemedicine, Medicare Part B, and home health.

In FY 2021, HHS-OIG reported 532 criminal enforcement actions against individuals or entities that engaged in crimes affecting HHS programs. It also reported 689 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. In addition, 1,689 individuals and entities were excluded from participation in federal healthcare programs. Read more about exclusions here.

The agency’s Christi A. Grimm, Principal Deputy Inspector General, noted that in May that her agency, along with law enforcement partners, targeted efforts against schemes designed to exploit the COVID-19 pandemic through genetic testing scams, which resulted in $143 million in false billings.

In September, the agency pursued charges associated with $1.4 billion in losses to the government in healthcare fraud cases that involved telefraud, COVID-19-related relief, substance abuse treatment facilities, illegal prescription and distribution of opioids, and other schemes.

Among some of the highlights from the report:

OIG, along, with it law enforcement partners, participated in a 6-week nationwide federal law enforcement action to combat healthcare fraud nationwide. The efforts resulted in criminal charges against 138 defendants, including more than 42 doctors, nurses, and other licensed medical professionals, for over $1.4 billion in alleged losses.

A prescriber was sentenced to 121 months in prison for participating in a scheme to receive bribes and kickbacks from a pharmaceutical company in exchange for prescribing millions of dollars worth of a potent fentanyl-based spray. Gordon Freedman received the bribes and kickbacks from Insys Therapeutics in the form of fees for sham educational programs. In exchange, Freedman prescribed enormous quantities of Subsys, a fentanyl-based spray manufactured by Insys. Freedman also was sentenced to 210 months in prison, to run concurrently with the other sentence, for distributing oxycodone and fentanyl to a patient for no legitimate medical purpose.

In September 2021, a Nationwide Law Enforcement Action resulted in 138 charged defendants across 51 federal districts, including more than 42 doctors, nurses, and other licensed medical professionals. These defendants were charged with submitting more than $1.4 billion in allegedly false and fraudulent claims to federal healthcare programs and private insurers.

The owner and operator of a purported medical clinic, QC Medical Clinic, was sentenced to 25 years in prison and ordered to pay $250,000 in restitution for participating in an $11 million Medicare fraud scheme. QC Medical Clinic sold fraudulent medical documents to home health agencies in and around Houston.

For more than 30 years, The Health Law Offices of Anthony C. Vitale has been representing clients under investigation by local, state and federal agencies. For more information you can contact us at 305-358-4500 or send us an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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