Exclusion Screening

Overview of OIG’s Semiannual Report


Emptech's founder, Jeff Aleixo


Jeffrey Aleixo

OIG's semiannual report healthcare compliance

At the end of May 2021, the United States Health and Human Services Office of Inspector General (HHS OIG) released its Semiannual Report to Congress. The OIG’s Semiannual Report outlines the office’s work during the six-month reporting period. Furthermore, it highlights actions taken to investigate pandemic-related fraud, harming individuals, and threatening public health efforts.

What Is OIG’s Semiannual Report

According to the Inspector General Act of 1978, Public Law 95-452, the Inspector General is required to provide semiannual to the head of the Department and the Congress regarding the activities of the office during the 6-month periods ending March 31 and September 30. The OIG’s semiannual report summarizes significant findings and recommendations by the Office of Inspector General.

The latest OIG’s Semiannual Report to Congress describes OIG’s work undertaken in the process of identifying significant risks, problems, abuses, deficiencies, remedies, and investigative outcomes relating to the administration of HHS programs. It also highlights operations that were disclosed during the semiannual reporting period from October 1, 2020, through March 31, 2021.

HHS OIG Work Plan

Apart from the OIG’s Semiannual Reports, the office releases Work Plan updates each month. Thus, they can inform the public about the projects undertaken during the year regarding auditing, reporting, and investigating HHS operating divisions, including the following: 

In addition to this, some of the projects described in the Work Plan are statutorily required.

Financial and Investigative Recoveries

During the timeframe covered by the report, OIG issued 75 audit reports and 20 evaluation reports in which HHS programs were audited and evaluated to improve efficiency and effectiveness, with an emphasis on preventing fraud and abuse. Those reports identified $566.46 million in expected recoveries based on alleged violations of laws and regulations, lack of documentation support, or unnecessary or unreasonable expenditures. 

Consequently, OIG’s Semiannual Report identified nearly one billion dollars in potential savings that can be achieved if HHS implements all the related recommendations. In addition, the OIG also made 228 new audit and evaluation recommendations to HHS agencies to make positive changes to their programs.

When it comes to investigative recoveries, HHS OIG worked with the Department of Justice, Medicaid Fraud Control Units, and other various law enforcement agencies to investigate and prosecute fraud. These efforts resulted in $1.37 billion in expected investigative recoveries and 221 criminal actions during the reporting period. Apart from this, the OIG took 272 civil actions including the assessment of monetary penalties and excluded 1,036 individuals and entities from federal health care programs.  

Use this detailed guide to remain compliant with healthcare regulations and avoid risks, and prevent potential costs.

The Impact of COVID-19

The OIG’s Semiannual Report also discusses the OIG’s enforcement efforts related to the COVID-19 pandemic. During the reporting period, OIG:

  1. Analyzed nursing home surveys for improvement opportunities,
  2. Conducted a survey of hospitals to evaluate how healthcare delivery was affected with COVID-19,
  3. Partnered with six federal OIGs to analyze COVID-19 testing, including the amounts paid by Medicare Part B for these tests, and
  4. Alerted the public about various types of fraudulent schemes relating to COVID-19.

OIG’s Semiannual Report also highlights that due to the COVID-19 pandemic, Medicaid beneficiaries were put at a greater risk of opioid misuse or abuse. From January to August 2020, at least 5,000 Medicare Part D beneficiaries suffered opioid overdoses each month. Thus, OIG pointed out how important it is that CMS and HHS monitor trends in prescriptions for certain drugs and take appropriate actions if the number of prescriptions begins to fall off.

Furthermore, OIG’s Semiannual Report points out that hospitals faced different challenges in healthcare delivery, access, and health outcomes due to operating in survival mode for extended periods of time. In addition to this, many hospitals reported financial instability due to increased pandemic-related expenses and lower revenues from the decreased use of other services. Therefore, the report reveals challenges that existed before and were additionally intensified by the pandemic.

HHS OIG Mission

HHS OIG is dedicated to combating fraud, waste, and abuse, improving the efficiency of HHS programs, and protecting the integrity of these programs and the well-being of its beneficiaries. Documents such as OIG’s Semiannual Report and Work plan reflect audits, inspections, evaluations, and investigative activities undertaken in support of OIG’s vision, mission, and strategic goals and objectives. As such, they represent an important source of information for all healthcare providers and organizations aiming to achieve healthcare compliance.

Another step necessary for compliance is the implementation of a thorough exclusion screening and continuous monitoring program to identify any excluded providers, staff, entities, vendors, and owners. The exclusion screening process is very complicated and time-intensive as it involves checking all federal and state exclusion lists for exclusions, sanctions, debarments, and disciplinary actions and then monitor these lists monthly. However, with exclusion screening software, organizations can automate continuous exclusion screening and monitoring, and receive timely alerts of any adverse actions. Taking this measure not only increases healthcare compliance but also protects organizations and providers from financial and reputational risk.

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