OIG Asks for Extra $10M, More ‘Boots on the Ground’ to Target Home- and Community-Based Fraud

The Office of the Inspector General (OIG) is making good on its long-held promise to ramp up oversight of home- and community-based services, requesting an extra $10 million in its fiscal year 2020 budget to tackle fraud, waste and abuse in those areas.

The extra funding — which would increase this portion of OIG’s budget from $26 million to $36 million — will be used to expand OIG’s capabilities to surveil home health, hospice, personal care and telehealth providers for mismanagement of government funds, according to OIG’s 2020 budget submission.

Specifically, $1.5 million would go toward development of new data models and tools to help OIG identify fraud schemes and trends; $4 million would fund resources to conduct reviews that would result in recommendations for new programs and improvements; and $4.5 million would go toward adding more “boots on the ground,” allowing OIG to open more investigations into suspicious activity.

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To justify the budget increase — which is more than three times the $3 million dollar bump OIG received for this portion of its budget between 2018 and 2019 — OIG pointed to the rising popularity of home- and community-based services.

“As more patients seek and receive a growing volume and range of services at home, the risks of fraud and abuse will likely increase,” the budget request says.

From fiscal year 2013 to 2017, home health investigations resulted in more than 450 criminal and civil actions and yielded $1.3 billion in expected receivables, according to OIG. Additionally, analysts have identified more than 500 home health agencies and over 4,500 physicians “with multiple characteristics commonly associated with home health fraud,” the request notes.

Fraud hot spots include Florida, Texas, parts of Southern California and the Midwest, all of which would be targeted by the additional funds.  

Further justifying the need for increased funding to increase oversight, the budget request estimates that, in 2017, there were $808 million in improper payments to home health providers, $4.42 billion in improper payments to group homes and immediate care facilities and $3.21 billion in improper payments to personal support service providers.

The budget ask comes as OIG recently released its 2018 Medicaid fraud control units’ annual report.

In it, OIG documented $545 million in civil Medicaid recoveries and $314 million in criminal Medicaid recoveries from 2018, totaling $859 million. The recoveries were the result of 1,503 convictions and 810 civil settlements and judgements.

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