Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities

The OIG won’t admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that’s the most likely explanation for the dramatic decline across all enforcement metrics documented in the agency’s most recent semiannual report for April to September 2018. This is both a continuation and acceleration of a trend that began last year.

OIG Enforcement By the Numbers Year Over Year
(April through September)

Metric 2018 2017
Expected investigative recoveries $3.43 billion $4.13 billion
Criminal actions against individuals or entities relating to HHS programs 764 881
Civil actions 813 826
Exclusions of individuals and entities 2,712 3,244

Labs Figure Prominently in OIG’s Newest Top 10 Challenges List
Although the OIG has its flaws, lack of transparency isn’t among them. Exhibit A: the agency’s ongoing list of top 10 management and performance challenges facing the Department of Health and Human Services in the coming year. Historically, the items change little over the years with maintaining Medicare and Medicaid program integrity topping the list. while not expressly spelled out, we all know that “program integrity” is code for billing and payment of lab and diagnostic services, among other things. 

But the newest list features a new number one: Curbing the opioid epidemic. Here’s the entire Top 10: 

Top 10 HHS Management & Performance Challenges 

  1. Curb Opioid Epidemic
  2. Ensure Medicare Program Integrity
  3. Ensure Medicaid Program Integrity
  4. Ensure Integrity in Managed Care and Other Programs Delivered via Private Insurers
  5. Protect Health and Safety of Vulnerable Populations
  6. Improve Financial and Administrative Management and Reduce Improper Payments
  7. Protect Integrity of Public HHS Grants
  8. Ensure Safety of Food, Drugs and Medical Devices
  9. Ensure Program Integrity and Quality in American Indian and Alaska Native Populations Programs
  10. Protect HHS Data, Systems and Beneficiaries from Cyber Threats
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