Updated on: May 31, 2019

HHS Anticipating nearly $3.5 Billion in Confirmed Recoveries for FY 2018

Original story posted on: May 29, 2019

OIG’s report to Congress profiles plenty of activity, including the ongoing battle against the opioid abuse epidemic.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is in the business of rooting out “fraud, waste, and abuse” in the nation’s healthcare system, to echo the oft-repeated phrase it uses to describe its mission.

And business is good.

The OIG is anticipating $2.9 billion in investigative recoveries and slightly more than half a billion more in audit recoveries for the 2018 fiscal year, according to a report recently delivered to Congress.

“OIG continues to serve the American people by providing objective, actionable information and recommendations to improve fiscal stewardship of HHS programs, ensure program beneficiaries receive high-quality services and hold those who harm taxpayers accountable,” HHS Inspector General Daniel R. Levinson said in prepared remarks released last week. “The dedication, professionalism, and expertise of OIG employees drive this high-impact work.”

The report went on to note that the OIG criminally charged 764 people in 2018, filed 813 civil actions, and excluded more than three times that number of individuals and entities from participating in federal healthcare programs.

Those activities included the bombshell June 2018 announcement that 600 people had been charged in what authorities described as the most significant national healthcare fraud takedown in history. That number included 162 defendants, including 76 doctors, charged for illegally prescribing and distributing opioids and other drugs. 

The fight against an opioid abuse epidemic that last year claimed more American lives (more than 70,000) that were lost in the entire Vietnam War continues to be a top priority for officials from the federal level all the way down to the local. In announcing the findings of its report, OIG also noted that it recently issued a data brief based on the results of a comprehensive analysis of opioid prescribing data in the Medicare Part D program.

The brief noted that nearly one in every three Medicare beneficiaries received an opioid prescription in 2017, including 71,000 beneficiaries given what OIG deemed a number of drugs that “put them at serious risk for opioid abuse.”

“OIG also identified about 15,000 beneficiaries who appeared to be ‘doctor shopping,’ a potentially dangerous practice where patients obtain high amounts of opioids from multiple prescribers and/or multiple pharmacies, generally without adequate care coordination to prevent the risk of overdose and abuse,” a press release outlining the findings read. “OIG also found that almost 300 prescribers engaged in questionable opioid prescribing by ordering opioids for the highest number of beneficiaries at serious risk of opioid misuse or overdose.”

The announcement also publicized a toolkit setting out OIG’s data-based methodology for identifying beneficiaries at high risk of misuse of opioids. Public and private sector stakeholders such as insurance plans are able to use the toolkit to analyze their own prescription drug claims data to identify patients at high risk of opioid misuse or overdose and target those individuals for potentially life-saving intervention.

To read the OIG press release in its entirety, which includes a link to the full report to Congress, go online to https://oig.hhs.gov/newsroom/news-releases/2018/sar.asp.


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Mark Spivey

Mark Spivey is a RACmonitor contributor who has been writing and editing articles about federal oversight of healthcare for nearly a decade. He can be reached at mcspivey@hotmail.com.

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