Do Budget Cuts Mean Fewer Health-Care Fraud Investigations?


When you’re faced with a smaller budget, you often have to make sacrifices, whether it’s cutting down on dinners out or cutting the cable cord. But in the case of the Health and Human Services Office of Inspector General, a smaller budget may mean fewer personnel and fewer health-care fraud investigations.

I recently spoke with Gary Cantrell, the OIG’s deputy inspector general for investigations, and he told me that every OIG agent carries a case load of eight to 10 investigations, so a drop in staffing means fewer investigations and fewer prosecutions. The OIG hit a peak in staffing in 2011 with 644 investigators and analysts, Cantrell said, but staffing is now around 600.

The Trump administration enacted a 90-day federal hiring freeze Jan. 22, and its recent budget proposal calls for deep cuts to HHS, all of which could leave the OIG with fewer resources.

Cantrell also discussed some of the major fraud trends facing the OIG, including the continued problem of opioid abuse. OIG investigations have uncovered numerous cases where opioids have been prescribed inappropriately, sometimes leading to overdoses. Cantrell said the OIG has also worked on many cases where claims have been submitted for noncontrolled substances that were never dispensed.

The Medicare Fraud Strike Force remains a chief anti-fraud weapon, Cantrell said, and continues to expand beyond the nine core Strike Force cities. For example, June 2016’s annual Strike Force recovery announcement covered 34 judicial districts and included 24 Medicaid Fraud Control Units, Cantrell said.

A video of my interview with Gary Cantrell is here.

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