America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds due to the work of the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.
The Fall 2021 Semiannual Report to Congress (SAR) highlights nearly $4 billion in expected recoveries as a result of HHS-OIG audits and investigations conducted during fiscal year (FY) 2021.The report summarizes the full year’s achievements and provides an overview of HHS-OIG’s activities for the reporting period comprising the last half of FY 2021 (April 1 through September 30).
The report expects approximately $787 million to be returned based on program audit findings and projects another $3 billion will be returned based on investigative work.
In an announcement, the OIG also highlighted other report findings:
COVID-19 had a devastating impact on Medicare beneficiaries in nursing homes in 2020. Two in five Medicare beneficiaries in nursing homes either had or likely had COVID-19 in 2020. Overall mortality in nursing homes increased to 22 percent in 2020 from 17 percent in 2019, with almost 1,000 more beneficiaries dying per day in April 2020 than in April 2019. About half of Black, Hispanic, and Asian beneficiaries in nursing homes either had or likely had COVID-19, compared to 41 percent of white beneficiaries.
States reported multiple challenges with using telehealth to provide behavioral health services to Medicaid enrollees in managed care organizations. The challenges included a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers protecting the privacy and security of enrollees’ personal information, and the cost of telehealth infrastructure and interoperability issues for providers. Some states also reported other challenges, including a lack of licensing reciprocity and difficulties with providers obtaining informed consent from enrollees.
HHS-OIG investigated COVID-19-related schemes to fraudulently bill Medicare for medically unnecessary testing and medical equipment. The government worked with law enforcement partners on a six-week investigation to combat health care 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.