HHS-OIG Reports Nearly $3 Billion in Expected Recoveries in Newly Streamlined Semiannual Report
America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.
The Spring 2024 Semiannual Report to Congress (SAR) highlights over $2.76 billion in expected recoveries resulting from HHS-OIG audits and investigations conducted during reporting period of October 1, 2023, through March 31, 2024.
HHS-OIG reported 712 criminal and civil enforcement actions against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters. HHS-OIG also excluded 1,795 individuals and entities from participation in federal health care programs.
Reflecting recent congressional reforms aimed at modernizing and streamlining reporting requirements, the newly restructured report is more concise and focused, enabling HHS-OIG to concentrate on the most critical issues and activities facing HHS. The revised SAR underscores the HHS-OIG’s oversight work completed during the reporting period, concentrating on the most significant challenges confronting the Department of Health and Human Services. Each year, the OIG identifies these pressing issues in its Top Management and Performance Challenges Facing HHS (TMCs) report. For 2023, the OIG has pinpointed five paramount challenges:
- Safeguarding Public Health
- Ensuring the Financial Integrity of HHS Programs
- Improving Outcomes in Medicare and Medicaid
- Protecting People Served by HHS Programs
- Securing Data and Technology
Highlights of HHS-OIG’s work in the SAR include:
The Consistently Low Percentage of Medicare Enrollees Receiving Medication to Treat Their Opioid Use Disorder Remains a Concern. OIG found that fewer than 1 in 5 Medicare enrollees with opioid use disorder received medication to treat their disorder. Certain groups of enrollees, such as older enrollees, enrollees without the Part D low-income subsidy, and female enrollees, faced greater challenges accessing treatment than did others. (See report OEI-02-23-00250.)
States Face Ongoing Challenges in Meeting Third-Party Liability Requirements for Ensuring That Medicaid Functions as the Payer of Last Resort. Prior OIG work identified several challenges State Medicaid agencies have encountered in their efforts to meet third-party liability requirements to help ensure that Medicaid functions as the payer of last resort. In this report, OIG found that States continue to experience challenges in their efforts to meet third-party liability requirements, such as difficulties obtaining timely and reliable coverage information from third parties. OIG recommended that CMS develop an action plan to address these challenges. (See report A-05-21-00013.)
Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes and CDC Has Improved the Nursing Home Reporting Process for COVID-19 Data in NHSN, but Challenges Remain. OIG found that nursing homes were especially impacted by the COVID-19 pandemic (OEI-02-20-00492) and faced challenges with: Staffing—including a significant loss of staff and substantial difficulties in hiring, training, and retaining new staff—causing many nursing homes to use outside staffing agencies to fill gaps, which had significant downsides including high costs and lack of familiarity with systems and residents; costs, testing protocols, personal protective equipment compliance, and vaccination rates after initial challenges were resolved; and implementing effective infection control practices. Additionally, OIG found that CDC struggled with the process for nursing homes to report COVID-19 data into the National Healthcare Safety Network (NHSN). While CDC has improved the nursing home reporting process and guidance, some challenges remain (OEI-06-22-00030). CDC’s continued efforts to improve NHSN user support and data quality are important for continued reporting on vaccinations and for future public health surveillance. (See reports OEI-02-20-00492 and OEI-06-22-00030.)
Gaps in Sponsor Screening and Followup Raise Safety Concerns for Unaccompanied Children. OIG found that gaps in the Administration for Children and Families’ (ACF’s) implementation of sponsor screening and followup calls create vulnerabilities that could impact the safety of unaccompanied children who are released to sponsors (OEI-07-21-00250). OIG identified the following gaps: In 16 percent of children’s case files, one or more required sponsor safety checks lacked any documentation indicating that the checks were conducted. For 19 percent of children who were released to sponsors with pending Federal Bureau of Investigation (FBI) fingerprint or State child abuse and neglect registry checks, children’s case files were never updated with the results. In 35 percent of children’s case files, sponsor-submitted IDs contained legibility concerns. The Office of Refugee Resettlement (ORR) failed to conduct mandatory home studies in two cases, and four other cases raise concerns about whether ORR guidance on discretionary home studies should offer more specificity. In 5 percent of cases, sponsor records within ORR’s case management system were not updated with child welfare outcomes or sponsorship history. In 22 percent of cases, ORR did not conduct timely safety and well-being follow up calls, and in 18 percent of cases, the calls were not documented in children’s case files. (See report OEI-07-21-00250.)
ACF Has Enhanced Some Cybersecurity Controls Over the Unaccompanied Children Portal and Data but Improvements Are Needed. ACF’s UC Portal is a web application used to collect, organize, and report sensitive data related to children who are in ACF’s care. The UC Portal is a key data source for reunification efforts for separated children and contains data on both children and potential sponsors. OIG recently found that ACF did not completely address OIG’s recommendation in a prior audit that it consistently perform user account reviews, potentially allowing malicious actors to gain unauthorized access to children’s sensitive data. OIG found that because ACF had not established policies and procedures to inventory and monitor cloud information, it was not able to accurately identify and inventory all of its cloud computing assets. OIG also found that ACF did not effectively implement some security controls, potentially making ACF data stored in certain cloud information systems at high risk of compromise (See report A-18-22-03200.)
During the spring SAR reporting period, HHS-OIG made 195 new audit and evaluation recommendations, which are crucial to encourage positive change in HHS programs. Meanwhile, HHS operating divisions implemented 213 prior recommendations, leading to positive impact for HHS programs and beneficiaries.
For additional information on HHS-OIG's ongoing and completed work, visit oig.hhs.gov.