OIG recovers $1.8B from providers

The federal government recovered $1.8 billion from healthcare providers and programs in the first six months of fiscal 2015, a federal watchdog has revealed.

Of the recoveries, $544.7 million was from audit receivables and $1.3 billion resulted from investigations, the Department of Health and Human Services Office of Inspector General said in its “Semiannual Report to Congress,” which was released Monday. Approximately $142 million of the investigation receivables were in non-HHS matters, resulting from work in Medicaid restoration. Compared to the first six months of FY 2014, the recoveries were down by $1.3 billion.

The OIG also reported 486 criminal actions against individuals who participated in crimes against HHS in the first half of fiscal 2015, which began Oct. 1, 2014. Report authors also noted there were 326 civil actions, including false claims, and 1,735 exclusions involving healthcare providers.

OIG's continued participation with Strike Force led to charges against 69 individuals or organizations, along with $163 million in recoveries. Strike Force, which consists of Medicare fraud teams that quickly identify and prosecute fraud, has worked with the OIG since 2009.

Affordable Care Act programs also were included in the semiannual report, which encompassed health insurance marketplaces, Medicaid expansion, use of state establishment grants and financial assistance payments. One report found that the Centers for Medicare & Medicaid Services was inadequate in contract planning and procurement. Additionally, Maryland misallocated $28 million in costs to establishment grants, according to the report.