On May 27, 2014, OIG released its Spring 2014 Semiannual Report to Congress, covering the activities of the OIG during the first half of Fiscal Year 2014, from October 2013 through March 2014.  For that time period, OIG reports expected recoveries of more than $3.1 billion.  OIG also reported 465 criminal enforcement actions, 266 civil actions, and 1,720 exclusions of individuals and entities from participation in federal health care programs.

The report touches on numerous aspects of OIG’s operations. Selected highlights include:

  • OIG states that it has increased oversight of implementation of the Affordable Care Act, including the Health Insurance Marketplaces.  Specifically, OIG has focused on eligibility systems, payment accuracy, contractor oversight, and data security.  
  • The report discusses the success of Medicare Fraud Strike Force investigations, which are coordinated federal, state, and local law enforcement operations.  During the first half of Fiscal Year 2014, Strike Force efforts resulted in recoveries of $294 million, 107 criminal actions, and charges filed against 94 individuals or entities.  
  • OIG also reports that it has identified numerous Medicare and Medicaid prescription drug vulnerabilities, including pharmaceutical manufacturer noncompliance, retail pharmacy and prescriber schemes, and flawed reimbursement methodologies.   
  • With regard to Medicare Administrative Contractor (MAC) activities, the report states that MACs did not meet one-quarter of the quality assurance standards reviewed and that MACs had not resolved 27 percent  of these unmet standards as of June 2012.  OIG recommended that CMS require action plans for unmet quality standards, among other suggestions. 

To read the full report, click here.