Outsource Medical Billing

OIG Report Findings

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently submitted a Semi-Annual Report to the Congress. As per the report, the OIG is hopeful that they will be able to recover approximately $5.6 billion spent by the Federal healthcare programs in fraudulent spending in the year 2016.

Reports indicate that the OIG will increase the use of civil actions in order to retrieve or recover this amount. A recent report from the OIG reported about 708 civil actions such as Civil Monetary Penalty settlements, administrative recoveries from provider self-disclosure matters, and federal false claims lawsuits. The report noted, “CMP recoveries have increased almost five-fold over the past three years.”

The OIG also reported about 844 criminal actions, which were filed against entities or individuals in FY 2016. Reports further indicate that OIG plans to concentrate deeply on prescription drug spending, as amounts spent on prescription drugs have significantly increased in the past few years.

The Office of the Inspector General also intends to continue strengthening their provider enrollment mechanism, as they believe that it would prevent abuse and fraud in the healthcare. An earlier report suggested that the CMS should strengthen their latest enhanced enrollment screening tools that are intended to stop illegitimate providers from enrolling in to the Medicare programs.

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Fraudulent Spending

The OIG had also released an updated 2017 work plan on the ongoing audits and on the evaluations for the next year. The report, which was released on November 21, provides a summary of the significant challenges faced by the HHS, and it also offers descriptions on how the health department is planning to resolve the issue.

Many of the issue highlighted in the report were longstanding concerns, which HHS was trying to minimize or resolve for years. In addition to that, a number of new concerns were also highlighted in the report. OIG also advised the CMS to pay attention to the improper billing claims like those provided to unlawfully present beneficiaries.

The integrity and efficiency of both Medicaid and Medicare programs are constantly being evaluated, as the health department is trying to achieve a great reliance on the value-based payments. The report by OIG also suggested some developments and modifications to the ACA based health insurance exchanges.

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