What the November 2025 OIG Work Plan Updates Reveal About Rising Enforcement Risk

November 2025 saw many new additions to the HHS OIG Work Plan.   

Let’s look at some of the highlights: 

CDC Compliance with Record Retention

Those who have watched news reports related to the CDC over the last year or two have noticed allegations and concerns about some of their record retention practices. Recently a Federal Judge ruled that the CDC has likely been violating federal law for years by systematically deleting lower-level employees’ emails (see the following as examples of news’ stories: https://www.politico.com/news/2024/08/09/cdc-records-lawsuit-ruling-00173416; https://thehill.com/policy/healthcare/4821251-judge-cdc-email-policy-likely-violates-federal-law/). 

The OIG has announced a Work Plan item to audit the CDC’s compliance with federal records management requirements.  According to the OIG, the Federal Records Act of 1950 (FRA) requires all Federal agencies to create and preserve records that document the agency's organization, function, policies, decisions, procedures, and transactions. The FRA calls for agencies to establish a records management program consisting of policies, procedures, and activities to manage recorded information.  

The Presidential and Federal Records Act Amendments of 2014 modernize records management by requiring the transfer of records from Federal agencies to the National Archives and Records Administration in digital or electronic form to the greatest extent possible.  

Effective and efficient management of records provides the information foundation for decision making at all levels, mission planning and operations, personnel services, Congressional and legal inquiries, business continuity, and preservation of U.S. history.  

With all this in mind, the OIG will conduct an audit to determine whether the Centers for Disease Control and Prevention complied with Federal records management requirements related to: (1) responding to incidents of records removal or destruction, (2) training for Federal employees, and (3) chain of custody for departing staff records. 

FDA's Oversight of Dietary Supplements

Dietary supplements seem to be ubiquitous in daily life. Some estimate the annual market size for dietary supplements in the U.S. is anywhere from $57 -$70 billion. 

The Food and Drug Administration (FDA) has the authority to regulate dietary supplements that are marketed in the United States. While they do not have the authority to approve dietary supplements before they are marketed, FDA's role in regulating dietary supplements includes activities such as inspecting dietary supplement facilities; investigating complaints; monitoring the dietary supplement marketplace; and reviewing adverse event reports to identify products that may be unsafe.  

The OIG plans to approach this Work Plan item in two phases. For the first phase of work, they plan to identify the number of domestic and foreign dietary supplement facilities: (1) registered with FDA by type, (2) due for inspection by FDA, and (3) that were inspected by FDA. For the second phase of work, OIG will conduct an audit to determine whether FDA's oversight of select dietary supplement facilities complied with Federal requirements. OIG estimates its report will be published sometime in 2027. 

Quality of Care in Nursing Homes

Nursing homes continue to remain in the cross hairs of enforcement agencies.  The OIG also continues to have their eye on many different aspects of nursing home care and compliance. 

In recent years, regulators and policymakers have raised concerns about the relationship between changes in nursing home ownership and low-quality care, which can endanger resident health and safety. CMS requires nursing homes to submit updated information within 30 days of a change in ownership.  

In addition, CMS and State survey agencies can assess the effect of ownership changes on quality by conducting an onsite survey, making a State monitoring visit, and/or requesting additional documentation.  

This OIG Work Plan study will evaluate the extent to which CMS and State survey agencies take actions to identify and respond to declines in nursing home quality related to changes in ownership. 

Home Health Claims and Outlier Payments

For many recent years, the OIG has been publishing various reports and audit results pertaining to Home Health services.  Links to approximately 15 of these reports can be found in the “Report Number(s)” column of this previously announced OIG Work Plan item found here: https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000100.asp 

Medicare requires providers to bill claims accurately to be paid correctly and promptly by Medicare Administrative Contractors (MACs). During previous home health agency compliance work, the OIG observed claims where providers incorrectly billed single-discipline visit units (greater than 8 hours) that resulted in overpayments equal to the outlier payment.  

MACs pay outlier payments on home health claims for enrollees who incur unusually large costs that are determined by the visit units billed on the claim. Nationwide home health claims data for the most recent 30-month period shows that the average duration of a home health visit is 45 minutes.  

This OIG audit will cover Medicare outlier payments for home health visits for single disciplines that were billed in excess of 4 hours. Their objective is to determine whether selected home health claims with outlier payments complied with certain Medicare billing requirements. 

Behavioral Health Clinics and Medicaid Reimbursement

Certified Community Behavioral Health Clinics (CCBHCs) provide whole-person, team-based care addressing both behavioral and physical health needs. They are required to offer a broad range of services, including crisis mental health care, case management, and integrated physical health screening.  

Certain legislation authorized the creation of a demonstration program for CCBHCs. States participating in the CCBHC demonstration receive Federal funds at the enhanced Federal medical assistance percentage (FMAP) for qualifying expenditures and are required to implement standardized certification and payment structures for CCBHCs.  

The OIG plans to determine whether select States participating in the CCBHC demonstration program claimed expenditures that were eligible for the enhanced FMAP and whether select CCBHCs provided the services required to receive Medicaid payments. The expected issue date of this report is sometime in 2027. 

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