On December 4, 2024, OIG issued its fall 2024 Semiannual Report to Congress (the Report), which provides a comprehensive overview of the agency’s work completed during the reporting period of April 1, 2024, through September 30, 2024.
The Report highlights over $7 billion in expected recoveries resulting from OIG audits and investigations for FY 2024, including $4.36 billion in expected recoveries during the reporting period. OIG reports 1,548 criminal and civil enforcement actions against individuals and entities suspected of engaging in crimes targeting HHS programs and the people they serve, including settlements resulting from using OIG's civil monetary penalty authorities and criminal convictions. According to the Report, OIG excluded 3,234 individuals and entities from participation in federal health care programs.
Further highlights include:
- Upon review of 100 for-profit nursing homes nationwide, OIG found that twenty-four did not meet federal requirements pertaining to infection prevention. OIG estimates that 2,568 (approximately 1 in 4) for-profit nursing homes nationwide may not have complied with Federal requirements for infection prevention during the review period.
- OIG found Medicare improperly paid hospitals an estimated $79 million for enrollees who had received mechanical ventilation. According to the Report, Hospitals attributed the improper billing to incorrectly counting the hours that enrollees had received mechanical ventilation as well as clerical errors in selecting procedure or diagnosis codes.
- OIG found that Medicare and some enrollees paid 80 percent more when Stelara injections were covered under Part D (i.e., self-administered) versus under Part B (i.e., administered by a physician). Stelara is a high-cost prescription biologic approved to treat certain autoimmune diseases. OIG’s findings indicate that the different methods used to set drug payments under Part B and Part D result in different payment amounts for the same drugs.
The Report is available here.
