The Fall 2021 Office of Inspector General (OIG) Health and Human Services Semiannual Report to Congress describes work identifying significant risks, problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs and operations that were from the reporting period of April 1, 2021, through September 30, 2021. The HHS programs include Medicare, Medicaid and other health and human services programs.

The FY2021 semiannual work of the HHS-OIG was able to recoup nearly four (4) billion dollars according to this recently released report. These figures represent approximately $787 million expected to be returned based upon program audit findings and another $3 billion estimated to be returned based upon investigative work. Yes, that is billions!!

In addition to the above work and financial figures, there were 532 reported criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs. The HHS-OIG also reported 689 civil actions taken, which includes false claims and unjust-enrichment lawsuits. A total of 1,689 individuals and entities were excluded from participation in the federal health care programs.

The OIG remains at the forefront of the Nation’s efforts to fight fraud in HHS programs and hold wrongdoers accountable for their actions. The report states that the OIG continues to focus on the most significant and high-risk issues in health care and human services. The mission of the OIG is to provide objective oversight to promote the economy, efficiency, effectiveness, and integrity of HHS programs, as well as the health and welfare of the people they serve.

The primary OIG areas of focus in the summary report are outlined here, however, note that there are many additional reports, audits, and investigations under each of these:

1. Responding to the COVID-19 Pandemic and Other Emergencies
2. Ensuring Health and Safety of Children Served by HHS
3. Preventing and Treating Opioid Misuse
4. Protecting Beneficiaries From Abuse, Neglect, and Unsafe Conditions
5. Protecting HHS Data, Systems, and Beneficiaries From Cybersecurity Threats
6. Protecting Medicare From Fraud, Waste, and Abuse
7. Promoting Integrity and Effectiveness in Managed Care
8. Ensuring Medicaid Program Integrity
9. Oversight of NIH Grant Programs and Operations
10. Promoting Payment Integrity in Departmental Programs
11. Insights in the Orphan Drug Designation Program
12. OIG Participation in Congressional Hearings
13. Medicare Program Reports and Reviews
14. Drug Spending and Reimbursement
15. Medicaid Program Reports and Reviews
16. Legal and Investigative Activities Related to Medicare and Medicaid
17. Medicare Fraud Strike Force Activities
18. Compliance Trainings
19. Most Wanted Fugitives List
20. HHS-OIG Hotline
21. Medicaid Fraud Control Units
22. Advisory Opinions and Other Industry Guidance
23. Sanction Authorities and Other Administrative Actions
24. Public Health and Human Service Agency Reports and Reviews (including the CDC)
25. Legal and Investigative Activities Related to Public Health and Human Service Agencies
26. Other HHS-Related Reviews and Investigative Activities (including Grants and Contracts)

Included in the semiannual report is a series of appendix:

Appendix A: Questioned Costs and Funds To Be Put to Better Use

Appendix B: Savings Decisions Supported by OIG Recommendations

Appendix C: Peer Review Results

Appendix D: Summary of Sanction Authorities

Appendix E: Reporting Requirements in the Inspector General Act of 1978

Appendix F: Reporting Requirements in the Inspector General Empowerment Act of 2016

Appendix G: Anti-Kickback Statute—Safe Harbors

You can download the OIG Press Release at: https://oig.hhs.gov/newsroom/news-releases-articles/2021-fall-sar/

A best practice is to obtain the OIG full summary report to Congress which is available at the following link and read through it: https://oig.hhs.gov/reports-and-publications/archives/semiannual/2021/2021-fall-sar.pdf