Semiannual OIG Reports to Congress Tally Nearly $3 billion in Expected Recoveries

The Employment Screening Services blog is dedicated to providing business owners and hiring professionals with news, tips, and info on the background screening industry. As a leading national provider of employment background checks, we hope to educate readers on why the industry is so important. We work with individuals all over the country to ensure they are making smarter hiring decisions. Today’s blog focuses on a recent report from the Office of Inspector General to Congress in the Spring of this year.

A Big Quarter for OIG Exclusion

In the Spring 2022 semi-annual report to the US Congress, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) “highlighted nearly $3 billion” in expected recoveries as a result of OIG audits and investigations. This is merely for the overview of the time between October 1, 2021, through March 31, 2022.

Read More: The World of OIG Exclusions | What, Where, Why?

According to the reports, 1,043 individuals and entities were excluded by the OIG from participation in healthcare programs. The OIG reported 320 criminal enforcement actions against individuals and/or entities that engaged in crimes affecting department programs. Unjust-enrichment lawsuits, false claims, civil monetary penalty settlements, and administrative recoveries relating to provider self-disclosures accounted for another 320 civil actions.

The report also demonstrates how nearly $3 billion is accounted for. $1.14 billion in expected audit recoveries, in addition to $1.6 billion in what are known as “questioned costs.” Questioned costs are “questioned” by the OIG because of an alleged violation, costs not supported by adequate documentation, or the expenditure of funds where the intended purpose is unnecessary or unreasonable.  From this reporting, the OIG also identified $162.1 million in potential savings for the HHS–funds that could be saved if HHS implemented all of OIG’s audit recommendations. 

See the full report from the OIG HHS Here

A few Examples of Excluded Individuals

In December of 2021, 2 owners of a durable medical equipment (DME) company were sentenced to 151 months in prison and ordered to pay more than $27 million in restitution for a Medicare kickback conspiracy. 

In November of 2021, 2 men were sentenced for their roles in a “conspiracy to defraud federal health benefit programs.” They ran a Tampa-based telemarketing company that “illegally bribed physicians” to sign thousands of medically unnecessary physicians’ orders for DME and cancer genetic testing. 

In December of 2021, a Texas home health care company owner that had fled to Cameroon following pleading guilty to two separate cases of conspiracy, healthcare fraud, money laundering, and tax offenses was finally put behind bars after being charged in November of 2016. 

1,043 Individuals Now Excluded

When the OIG HHS excludes an individual or entity, they can receive no payment from Federal healthcare programs for any items or services they furnish, order, or prescribe. This includes those that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan). 

If your organization has any questions about ensuring all of your healthcare employees are not on the OIG HHS List of Excluded Individuals and Entities, don’t hesitate to reach out and give us a call. We work with organizations all over the country to provide OIG exclusion searches and can run mass searches for large organizations to help you stay in compliance. Thanks for reading and stay tuned for more news on what makes background screening so important!