Billions Of Dollars In Taxpayer Money Could Be Recovered; Lax Child Protection In CO, MO: HHS Report

December 7, 2021

By a Biometrica staffer

Last week, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) released its Fall Semiannual Report to Congress, in which it was found that the efforts of the HHS in the 2021 fiscal year could potentially “recoup” almost $4 billion in taxpayer money that was falsely spent on Medicare, Medicaid, and other programs.

According to the report, in FY 2021, “$787 million is expected [to] be returned based on program audit findings and $3 billion is expected to be returned based on investigative work.” The main purpose of the HHS-OIG is to “detect, investigate, and prosecute fraud through a coordinated and data-driven approach,” as it specifically relates to HHS programs like Medicare and Medicaid.

Over this year, HHS-OIG reported 532 “criminal enforcement actions against individuals or entities that engaged in crimes that affected HHS programs” and 689 civil actions. In addition, this year, a total of 1,689 people and companies were excluded from participating in federal healthcare programs ever again.

Earlier this year, in July, another report revealed that a total of $3.1 billion in false and fraudulent claims was recovered and returned to the federal government or individual persons in the 2020 fiscal year.

When it comes to protecting children, the report found that the state of Colorado’s monitoring process did not ensure that childcare providers were complying with state criminal background check requirements for 18 of the 30 providers reviewed. The state “did not retain criminal background check records for child care center individuals,” the report says. It also did not mandate training on background check requirements. Further, the report adds, “providers did not always inform the State and properly obtain background checks when hiring individuals or when new individuals began to reside in family homes.”

In the case of Missouri, HHS-OIG found that the state’s foster care agency “ rarely attempted to reduce children’s risk of going missing,” failed to protect missing children, and did not “effectively use resources” to help find the children. These children were then “exposed to additional risks” like being trafficked for sex or a greater likelihood of having interactions with the criminal justice system.

In relation to elderly people, two out of every five of those on Medicare and in nursing homes in 2020 either did or likely contracted Covid-19. In nursing homes, mortality rose to 22% in 2020, versus 17% the previous year. At the peak of the pandemic, in April 2020, there were almost 1,000 more beneficiaries dying per day than in the same month the previous year. Over half of those Medicare beneficiaries who were hospitalized due to Covid-19 had to receive intensive care or mechanical ventilation. 

Racially, around 41% of white beneficiaries of Medicare in nursing homes either had or likely had Covid-19, compared to the nearly 50% rate noted among Black, Hispanic, and Asian beneficiaries. Those who were Black and Hispanic were also hospitalized at disproportionately higher rates.

HHS-OIG also found lax standards and oversight in regard to cybersecurity for medical devices in hospitals. This is particularly worrying, as hospitals were a major target for cybercriminals and ransomware attacks last year, as we wrote about a few months ago. In addition, the pandemic created greater demand for telehealth services, which many states struggled to provide to Medicaid enrollees. Among the challenges on this front were lack of training, poor internet connectivity, and inadequate protection of the privacy and security of personal data.

The OIG almost made a series of recommendations based on its audits of the HHS and found that the department could potentially save up to $318.91 million if all are implemented.

You can read the full report from HHS-OIG here.