OIG's April 2023 Testimony — Agency Staffing Shortages, Impacting Fraud Case Load
Key Highlights:
At current state, OIG risks being unable to keep pace with fraud threats.
Healthcare Fraud accounts for between 3% and 10% of total healthcare spending in the United States, roughly $129 billion to $430 billion, is lost to fraud each year.
OIG turned down 650 cases (a 10% increase from the prior year) of potential fraud from CMS last year due to a lack of staff.
On April 18, 2023, The HHS Inspector General provided testimony before Congress – subcommittee on “Oversight and Investigations” reported details of HHS's Unaccompanied Children (UC) Program, grants management with a focus on National Institutes of Health (NIH) grants, and the Centers for Medicare & Medicaid Services (CMS), including unwinding the COVID-19 public health emergency (PHE).
Across CMS, HHS-OIG is aggressively combating fraud and abuse to protect taxpayer dollars from theft, misuse and to protect patients from harm. Based on the HHS Inspector General's Testimony, OIG lacks adequate staffing resources to keep up with the level of fraud, waste, and abuse for HHS programs that currently involve more than $2.4 trillion in HHS expenditures in Fiscal Year 2022.
Recent OIG research estimated that between 3 percent and 10 percent of total healthcare spending in the United States, roughly $129 billion to $430 billion, is lost to fraud each year. The HHS Inspector General continues to comment that, The OIG turns down hundreds of viable criminal and civil healthcare fraud cases yearly due to inadequate investigators and analytical staff. OIG’s agents and investigators are in demand by prosecutors for their expertise in HHS’s health care programs, policy, and the fraud schemes that exploit them.
The OIG received more than 3,562 hotline complaints last fiscal year that could have developed into viable cases but had inadequate resources to address them. They also turned down nearly 650 cases from CMS, an almost 10 percent increase in the percentage of cases declined from the prior year.
The OIG's 2023 budget is $432.5 million, or about 2 cents, to oversee every $100 of HHS spending. These resources resulted from last year in approximately $2.7 billion in expected investigative recoveries and 1,446 criminal and civil actions, and the exclusion of 2,332 individuals and entities from participating in federally designated health care programs.
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References:
US House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, U. S. (2023, April 18). Insights from the HHS Inspector General on oversight of Unaccompanied Minors, grant management, and CMS. Office of Inspector General | Government Oversight | US Department of Health and Human Services. Retrieved May 3, 2023, from https://oig.hhs.gov/newsroom/testimony/insights-from-the-hhs-inspector-general-on-oversight-of-unaccompanied-minors-grant-management-and-cms/
Journal of the American Medical Association, Waste in the US Health Care System: Estimated Costs and Potential for Savings; Eliminating Waste in US Health Care; and Federal Bureau of Investigation, 2009 Financial crimes report (available at http://www.fbi.gov/stats-services/publications/financial-crimes-report-2009).
