The Department of Health and Human Services Office of Inspector General (OIG) is asking for an additional $22.8 million for fiscal year 2019 to maintain its focus on healthcare fraud enforcement, which has relied heavily on data analytics in recent years.
The agency is asking for $387.5 million in 2019, including $307.5 million to maintain oversight of the Medicare and Medicaid programs, according to a Congressional budget justification (PDF) released by the agency this week. The request includes an additional $23.7 million for the Health Care Fraud and Abuse Control Program that has gradually relied more heavily on sophisticated data analytics.
That technology is particularly helpful as the OIG looks to crack down on opioid fraud and drug diversion. The agency highlighted several instances last year in which law enforcement broke up pill mills by using analytics to identify hotspots of overprescribing.
“OIG continues to improve its capabilities to provide quality, timely and actionable data to frontline staff and to its public and private sector partners,” Inspector General Daniel Levinson wrote in the budget request. “OIG will continue to use data and technology to support its dedicated and talented personnel in their mission to strengthen HHS program integrity.”
Levinson added that the HCFAC program returned $5 for every $1 invested in the program in 2016, thanks, in part, to its data-driven approach. The Centers for Medicare and Medicaid Services (CMS) has implemented its own analytics system geared toward fraud prevention, but precise costs savings associated with the system have been difficult to pin down.
The agency has frequently pointed to the impact of analytics to root out fraud, which has contributed to annual busts involving hundreds of people. Last year’s record takedown involved 412 people across 41 districts amounting to $1.3 billion in fraudulent payments. Over the last three years, those coordinated busts have netted nearly $3 billion.
Last year, OIG’s chief data officer said analytics played a key role in teasing out a $1 billion fraud scheme that was “hiding in the data.”