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OIG Announces Expected $1.2 Billion In Recoveries for First Half of FY 2012

Friday, June 1, 2012
By James Swann

The Department of Health and Human Services Office of Inspector General May 29 announced expected recoveries from federal health care programs of roughly $1.2 billion for the first six months of fiscal year 2012, due in part to an increased focus on technology solutions, according to the agency's Semiannual Report to Congress.

“We are using advanced data analytics to help us conduct risk assessments; more effectively pinpoint our oversight efforts; and significantly reduce the time and resources required for audits, investigations, evaluations, and other program integrity activities,” OIG Inspector General Daniel R. Levinson said in the report's introduction.

Under the Inspector General Act of 1978, the OIG is required to file semiannual reports to Congress detailing program activities. The current report covers Oct. 1, 2011, to March 31, 2012.

During the first half of fiscal 2012, Medicare Fraud Strike Force operations recovered $51 million and led to the filing of charges against 101 individual or entities.

Data Warehousing's Role.
Levinson said the evolution of data warehousing has helped drive OIG audits and investigations as the “warehouse integrates data from Medicare Parts A, B, and D so we can develop a more comprehensive picture of beneficiaries' histories of medical care and providers' billing patterns.”

Data warehousing and data analytics have played key roles in Medicare Fraud Strike Force operations during the first half of FY 2012, Levinson said, and have also factored into OIG's ongoing hospital compliance review.

OIG has been evaluating acute-care hospitals to ensure their compliance with federal health care program requirements, Levinson said, and data analysis has helped identify compliance risks.

During the first half of fiscal 2012, strike force operations recovered $51 million and led to the filing of charges against 101 individual or entities.

In addition to the expected recoveries, the OIG also reported excluding 1,264 individuals and entities from participating in federal health care programs over the first half of FY 2012, as well as initiating 388 criminal actions and 164 civil actions against individuals and entities.

By James Swann


The OIG Semiannual Report to Congress is at http://oig.hhs.gov/reports-and-publications/archives/semiannual/2012/spring/sar-S12-fulltext.pdf.

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