OIG Expects to Recover $5.9B in Fraud Investigations, Doubling Last Year’s Haul

The Office of Inspector General (OIG) recovered $5.9 billion from fraud investigations during the fiscal year 2019, according to a semiannual report (PDF) to Congress released Monday.

That’s more than double from last year when the agency reported pulling in $2.9 billion; officials said they saw fewer large settlements.

The agency pointed to its “first-of-its-kind investigation” of a major genetic testing fraud scheme in 2019 which ultimately resulted in a $42.6 million settlement. They also pointed to charges against 24 telemedicine and medical equipment company executives and physicians for their alleged participation in a $1.2 billion healthcare fraud scheme.

Among the OIG’s activities, the agency said it:

• Brought 809 criminal actions against individuals or organizations accused of engaging in crimes against Department of Health and Human Services programs.
• Brought nearly 700 civil actions including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements and administrative recoveries related to provider self-disclosure matters.
• Excluded 2,640 individuals and entities from participation in Medicare, Medicaid and other federal healthcare programs.

Source: https://www.fiercehealthcare.com/payer/oig-reports-5-9b-misspent-healthcare-funds-could-be-recouped