Healthcare Enforcement in 2018: OIG Year in Review

healthcare enforcementThese are just a few of the numbers released highlighting the Office of Inspector General’s 2018 healthcare enforcement performance.  Another impressive number is the greater than $3 billion that HHS OIG is expecting to recover for healthcare crimes committed in 2018.

  • 2,712 entities and people have been excluded from participating in Federal healthcare programs. Of those excluded, 587 are barred from Federal healthcare program participation due to their activities related to opioid abuse.  76 of the 162 defendants were physicians prescribing and distributing opioid and other drugs illegally.  Altogether, more than 600 people were arrested in June last year, calling it the “largest national healthcare fraud takedown in history.”[i]
  • 764 criminal actions and 813 civil actions were brought against organizations and the people committing crimes against HHS, and us insured taxpayers.

A toolkit has been published by the OIG laying out their data driven methods to identify high risk patients concerning opioid use/misuse.  This is available to both private and public participants and insurance companies through utilizing data from prescription claims to trigger an alert regarding patients that are at a high risk of overdose or misuse.

[i] OIG expects $2.91 billion in investigative recoveries for FY 2018, according to its Semiannual Report to Congress. U.S. Department of Health and Human Services Office of Inspector General. News release 2018.

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