For years, the Department of Health and Human Services Office of Inspector General (OIG) has been ramping up efforts to battle Medicare fraud — including in home health and hospice. Now, a new OIG semiannual report is showing the agency’s progress, to the tune of $2.91 billion in expected investigative recoveries for fiscal year 2018.
Throughout 2018, OIG has repeatedly said it’s ramping up its oversight because fraud and improper billing cost the government hundreds of millions of dollars each year, even testifying to Congress on how to combat Medicare and Medicaid fraud and overpayments.
In the past several years, home health agencies have been top targets. In 2016, OIG flagged 500 home health agencies and 4,500 physicians for using suspicious practices. And earlier this year, OIG called out the hospice industry, identifying vulnerabilities in the Medicare Hospice Program and keeping an eye out for illicit marketing maneuvers and unlawful physician kickback arrangements.
“Increasingly, we’re uncovering fraud schemes that are quite concerning,” Jodi Nudelman, regional inspector general for OIG, told HHCN in August. “Particularly when beneficiaries are just unaware that they’re even being enrolled in hospice.”
In fiscal year 2018, investigations resulted in criminal actions against 764 individuals or entities and civil actions against 813. More than half of those — 305 criminal and 449 civil actions — and $1.4 billion in investigative receivables came between April 1 and September 30, the period for which the semiannual report covers.
While fraud recovery amounts aren’t broken down by category, Medicaid fraud was identified as a top priority area for OIG, according to the report.
Litigation against a home care company out of Virginia serves as an example detailed in the report.
Hope In-Home Care, LLC, which was accused of submitting false claims to the Virginia Medicaid Program, agreed to pay $3.3 million in a settlement to resolve allegations of fraud from January 1, 2011 to September 30, 2013.
Hope submitted claims for uncertified personal care aides, billed for services that were never performed, falsified documents and claims, among other allegations, according to the report.
The settlement is just one of many victories for OIG during the semiannual report period, which helped contribute to more than $1 billion in aforementioned investigative recoveries.
In addition, the OIG report shed some light on how the agency targets investigations, specifically outlining the important role that tips play in fraud detection.
Hotline complaints and online fraud reporting helped OIG recover $27 million over a six-month period, according to the semiannual report.
HHS’ OIG hotline received 60,390 calls between April 1 and September 30, resulting in 3,051 tips the office recommended for action, the report says. Meanwhile, it also detailed that 3,618 tips referred for action came through OIG’s website, while 1,300 came through letters or faxes. Additionally, 227 useful tips came via other avenues, according to the report.
Written by Bailey Bryant