OIG Releases Semi-Annual Report to Congress

On December 3, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) released its Semi-Annual Report to Congress (Report) for the 6 month period ending September 30, 2008. In the Report, the OIG reports savings and expected recoveries of over $20.4 billion for fiscal year (FY) 2008.

According to the OIG, the $20.4 billion includes:

• $16.72 billion in implemented recommendations to put funds to better use;
• $1.33 billion in audit receivables; and
• $2.35 billion in investigative receivables. 

For FY 2008, the OIG also reports:

• Exclusions of 3,129 individuals and entities for convictions for health care related crimes, for patient abuse or neglect, or as a result of license revocation;
• 775 criminal actions against individuals or entities engaged in crimes against departmental programs; and
• 342 civil actions, which include False Claims Act and unjust enrichment suits, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosures. 

The Report highlights the specific OIG accomplishments pertaining to the Medicare program.

In Appendix D of the Report, the OIG also provides Congress with its responses to the 2007 annual solicitation for proposals to develop or modify existing safe harbors to the Federal anti-kickback statute, as well as the OIG responses to some proposals submitted in prior years.  In fact, in response to the 2007 annual solicitation, the OIG provides responses to the following proposals:

• New safe harbor for any arrangement that satisfies a physician self-referral statute exception;
• New safe harbor for compensation paid to physicians providing on-call coverage services in hospital emergency departments;
• Revocation of the group purchasing organization safe harbor;
• New safe harbor to protect discounts, rebates, and other price concessions on prescription drugs given to Medicare Part D drug plan sponsors, retiree prescription drug plans, or their pharmacy benefit managers by pharmaceutical manufacturers, subject to certain safeguards;
• New safe harbor for compensation arrangements between members of the same corporate family;
• Clarification of the specialty referral safe harbor for certain collaborative relationships between advance practice nurses and physicians; and
• New safe harbor for gainsharing arrangements between hospitals and medical staff physicians.