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OIG: Investigative Recoveries to Top $2 Billion for First Half of FY 2017

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) estimates that investigative recoveries would be more than $2 billion for the first half of fiscal year (FY) 2017, according to the agency’s Semiannual Report to Congress. The report, which covers the period from October 1, 2016 to March 31, 2017, details the Health Care Strike Force’s efforts, which resulted in charges against 49 individuals or entities, 152 criminal actions, and more than $266.8 million in investigative receivables. Overall during this period, OIG reported 415 criminal and 458 civil actions against individuals or entities that engaged in healthcare-related offenses.

One of the report’s highlights is the investigation of the Medicare Part D catastrophic coverage. OIG noted that federal payments for Part D catastrophic coverage had more than tripled in the five years from 2010 to 2015. One of the principal causes of this dramatic increase was identified as payments for 10 high-priced drugs that accounted for almost one-third of all drug spending for catastrophic coverage in 2015. OIG notes that the cost of high priced drugs must be a continuing area of focus for The Centers for Medicare & Medicaid Services (CMS) due to the detrimental effect on Medicare solvency. The OIG suggests that CMS will need to consider various options when considering how to deal with high drug costs, including restructuring the Part D benefit, creating more transparency concerning drug pricing, promoting value-based options, and allowing the federal government to negotiate drug prices.

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The OIG also highlighted its efforts to improve the Indian Health Services (IHS), noting that the IHS had missed opportunities to improve services and monitor quality of care. Specifically, OIG had recommended that IHS implement a quality compliance program, establish standards for oversight activities, identify additional performance metrics, and continue to invest in training of hospital administrators. The OIG notes that the IHS suffers from multiple deficiencies including, most prominently, the inability to recruit and retain the staff needed to treat the increasing number of patients with complex medical issues.