OIG leadership talks fraud, enforcement

The Office of the Inspector General posted a video on its website covering the top priorities of its healthcare activities for 2013.

In the video, Roberta Baskin, OIG's director of media relations, speaks with several members of OIG's leadership about their oversight efforts. With healthcare expenditures accounting for nearly 25 percent of the federal budget, "the ability to maintain effective oversight is crucial," she said.

Inspector General Daniel R. Levinson said that the OIG's responsibilities regarding the agency's mission of making the nation's healthcare programs more effective and efficient "have increased and efforts expanded. The change in healthcare is more dynamic than ever." He cited EHRs as both a tool to help undercover fraud and abuse of the Medicare and Medicaid programs as well as something to guard against because of cybersecurity threats. The OIG is using more and more sophisticated tools to protect Medicare, he said, including "routinely analyzing data to discover new trends in criminal behavior."

Principal Deputy Inspector General Laeey Goldberg said that the OIG doesn't talk much about the enforcement activities listed in the annual OIG Work Plan on purpose. For one thing, the agency doesn't plan its enforcement activities in advance. Plus, enforcement is a response to uncovering evidence of fraud. "We don't publicly discuss ongoing investigations to protect the subjects' due process rights" as well to protect the investigation itself. The agency uses everything from undercover operatives to data analysis in its work, he said.

Deputy Inspector General Stuart Wright said the OIG's program evaluation projects uncover overpayments and deficiencies in quality of care. For example, his team found that 13 percent of Medicare beneficiaries admitted to the hospital received care that was harmful and resulted in permanent harm while another 13 percent received care that resulted in temporary harm. With the new penalties for 30-day hospital readmissions, Wright said that his team will build on its earlier work and "review the care that Medicare beneficiaries receive once discharged from the hospital to other post-acute care settings."

The "top cop in the OIG's law enforcement efforts," Gary Cantrell is the deputy inspector general for investigations. He said data analytics has always been a part of his 600-member investigations team but is even more so today. Data analytics helps the OIG identify fraud hotspots and there are now nine "Medicare fraud strike forces" as a result. Cantrell also oversees investigations of potential fraud among Department of Health & Human Services grants. The agency is the largest grant provider in the federal government. He said the OIG's efforts are "having a tremendous impact." For every dollar spent on investigations, seven dollars are returned to the Medicare trust fund.

View the entire video on the OIG website.