OIG Recovers More Than $2 Billion in Civil Monetary Penalties This Year

HCPRO Website, June 13, 2016

The Office of Inspector General (OIG) recovered more than $2.77 billion in civil monetary penalties (CMP) during the first half of the year, according to the office’s Semiannual Report to Congress, released May 31. The OIG expects that figure to continue to rise through the second half of the year.

According to the report, roughly $554.7 million of the total was recovered from audit receivables and $2.22 billion in investigative receivables. More than $330 million of investigative receivables was recovered from non-HHS sources such as state shares of Medicaid restitution.

The OIG’s investigations this year resulted in 428 criminal charges against individuals or entities and 383 civil actions, including false claims lawsuits and administrative recoveries related to provider self-disclosure matters. More than 1,600 individuals and entities were excluded from participation in federal healthcare programs.

This year’s rise in CMP recoveries is part of a trend that’s seen CMP recoveries increase nearly five times over the past three years, the report says. The OIG expects this year’s CMP recoveries to surpass the amounts recovered in previous years.

The OIG’s healthcare fraud strike force teams’ efforts alone netted $116.8 million in investigative receivables, 100 criminal actions, and 87 charges against individuals or entities during the first half of the year. The strike force teams are a component of the OIG’s Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT strike teams coordinate law enforcement operations, including investigation and prosecution of fraud. Strike force models operate in select cities, including Miami, Chicago, and Dallas.

The OIG is required to create semiannual reports for HHS and Congress detailing the activities of the office during the previous six months. The report highlights problems, abuses, and deficiencies the OIG found in HHS programs and investigative outcomes.