Top Highlights from the OIG’s Semiannual Report to Congress

Would you like to save nearly $4 billion dollars? Well, according to the most recent semiannual report to Congress, the U.S. Department of Health and Human Services Office of Inspector General (OIG) believes that is how much they could save taxpayers.  For those who don’t know, twice per year the OIG submits a summary report to Congress that describes their recent work, as well as recommendations to safeguard HHS dollars. It’s a long report (over one hundred pages), so let's cover some of the highlights.  

First, here are some work items mentioned by the Inspector General herself in the report’s introductory message:

• OIG’s investigative work led to $1.29 billion in expected investigative recoveries during this reporting period (April 1, 2022 – September 30, 2022).
• OIG audits and evaluations resulted in recommendations for improvement on issues such as reducing patient harm in hospitals, better protecting children in foster care from sex trafficking, and strengthening the cybersecurity posture for HHS.
OIG work helped propel meaningful improvement in the quality and safety of care in more than 15,000 Medicare- and Medicaid-certified nursing homes nationwide.
• OIG leverages data and cutting-edge technology to detect risks and strategically plan the most high-impact oversight across HHS programs and services.

Other highlights embedded in the report included some of the following topics.  OIG Oversight Work Related to COVID-19Some of the reports OIG issued with respect to COVID-19 included:

• FDA Repeatedly Adapted Emergency Use Authorization Policies To Address the Need for COVID-19 Testing (OEI-01-20-00380), September 2022
• FDA’s Work With the Tri-Agency Task Force for Emergency Diagnostics Helped Labs Implement COVID-19 Tests (OEI-01-20-00381), September 2022
• HHS Did Not Fully Comply With Federal Requirements and HHS Policies and Procedures When Awarding and Monitoring Contracts for Ventilators (A-02-20-02002), September 2022
• HHS’s and HRSA’s Controls Related to Selected Provider Relief Fund Program Requirements Could Be Improved (A-09-21-06001), September 2022

Enforcement Involving Physicians

A Georgia pain management physician paid $409,809.88 in a settlement agreement resolving allegations that he submitted claims to Medicare for facet joint injections and denervations that exceeded the allowable number of sessions in a rolling 12-month period.

A Minnesota physician entered into a $919,644.34 settlement agreement that resolved allegations he knowingly presented claims to Medicare for items or services that he knew or should have known were not provided as claimed and were false or fraudulent. Specifically, he submitted claims for:

1. Using CPT^® Code 95937 (neuromuscular junction testing) when the neuromuscular junction testing was either not medically necessary or was not performed at the applicable standard of care; and
2. Using CPT^® Code 95913 (for 13 or more nerve conduction studies) when he performed only 12 or fewer nerve conduction studies.

An Arizona chiropractor agreed to pay $1,905,070.74 to settle allegations that he submitted false claims to Medicare for:

1. Implantable neurostimulator devices using HCPCS Code L8679 when they instead provided auricular peripheral nerve stimulation devices that are not covered by Medicare;
2. CPT^® Codes 95970, 64555, and 64999 that were associated with the application, monitoring, and removal of the device; and
3. CPT^® Codes 99211, 99212, and 99213 for evaluation and management (E&M) services billed on the same date of service as HCPCS Code L8679 was billed for time spent providing and removing the device when no separate and identifiable E&M service was provided.

Settlements From Provider Self-Disclosures

• Hospitals in Illinois agreed to pay over $6.2 million after they self-disclosed and OIG alleged they submitted claims to Medicare for inpatient psychiatric admissions that were not medically necessary.
• A Maryland anesthesia organization self-disclosed conduct to the OIG regarding billing by certified registered nurse anesthetists (CRNAs). The organization agreed to pay $1,117,684.50 after OIG alleged the organization submitted claims for services provided by CRNAs who were not authorized to bill for their services on behalf of the organization, so they billed for services under the name of another CRNA who was authorized to bill on behalf of the organization.

Hospitals That Entered into Corporate Integrity Agreements

• An Oklahoma heart hospital entered into a $1,151,770.50 False Claims Act settlement agreement with the Department of Justice and OIG. The United States alleged the hospital billed Medicare for intensive cardiac rehabilitation that was not provided under a plan established, reviewed, and signed by a physician, or not updated, reviewed, and signed by a physician every 30 days.
• Paying kickbacks is alive and “kicking” (pun intended). A hospital in Michigan agreed to pay $1,732,548 for allegedly violating the Civil Monetary Penalties Law by paying kickbacks. OIG alleged the hospital:

1. 1. Paid remuneration to cardiologists in the form of excess compensation, and
   2. Paid remuneration to a medical practice in the form of free use of medical equipment and personnel.

Conclusion

This only covers some of the highlights. Reading the report in its entirety here can provide compliance professionals with valuable insights into key risk areas and focuses for the OIG.

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