OIG Receives Boost in Federal Fraud and Abuse Funding and Actions
American Academy of Sleep Medicine
Friday, May 08, 2009
While the House and the Senate have approved the 2010 Budget Resolution, there are many details to be developed still. One program that is scheduled to receive a budget boost will be the "program integrity" initiatives to increase oversight and eliminate fraud and errors in federal programs, including Medicare and Medicaid, as reported by the Wall Street Journal. The requested budget amount for these activities will be for $13.7 billion over five years, with $1.7 billion over five years to police health care fraud. The Administration estimates that every dollar HHS spends addressing health care fraud results in $1.60 in cost reductions. In total, Administration officials estimate that all of these initiatives will result in $35 billion in savings through increased tax revenue and lowered benefit payments.
The HHS OIG presented testimony to the Senate Special Committee on Aging on fraud in the Medicare and Medicaid programs. He stated: "The U.S. spends more than $2 trillion on health care every year. The National Health Care Anti-Fraud Association estimates conservatively that at least 3% - or more than $60 billion each year - is lost to fraud. Although it is not possible to measure precisely the extent of fraud in Medicare and Medicaid, everywhere it looks OIG continues to find fraud against these programs. In addition to the enforcement actions cited above, OIG opened 1,750 new health care fraud investigations in FY 2008." The referenced actions for FY 2008 were "455 criminal actions against individuals or entities that engaged in crimes against departmental programs and 337 civil and administrative actions, which included False Claims Act and unjust enrichment lawsuits filed in Federal district court, Civil Monetary Penalties Law settlements, and administrative recoveries related to provider self-disclosure matters. Also in FY 2008, OIG excluded 3,129 individuals and entities for fraud or abuse that affected Federal health care programs and/or our beneficiaries."