OIG says shift to data analytics is ‘paying dividends’ even as fraud recoveries dip in 2017

Special report: Homegrown fraud task forces promote collaboration
OIG's Daniel Levinson says analytics continue to be influential in large-scale fraud busts.

The Office of the Inspector General is maintaining its acute focus on data analytics to root out fraud, waste and abuse, an approach that has allowed the agency to identify pockets of fraudulent activity and dedicate resources to areas in need of targeted oversight.

“Sophisticated data analytics” were particularly influential in helping the agency carry out a $1.3 billion fraud bust earlier this year, according to Department of Health and Human Services Inspector General Daniel Levinson.

That record takedown in July, involving 412 people across 41 federal districts, continued what has become an annual tradition for the OIG and federal law enforcement agencies. Over the last three years, those national busts have netted nearly $3 billion in recoveries and charged almost 1,000 people.

RELATED: Feds charge more than 400 in national fraud bust

“Data and our growing data analytics capabilities played a significant role in these efforts,” Levinson said in the agency’s semiannual report to Congress. “We continue to cultivate a workforce with the skills and talents to excel in a data-driven oversight environment. This strategy is paying dividends for the American public.”

In 2017, those dividends totaled $4.13 billion, down from last year’s unprecedented $5.6 billion in recoveries. Criminal actions totaled 881, up slightly from 2016. Civil actions continue to climb, reaching 826 in 2017, but civil monetary penalties dropped from $38.4 million in 2016 to $22.8 million.

Listed among the OIG’s year-end highlights was the $155 million settlement with eClinicalWorks, accused of undercutting the EHR certification program and causing providers to submit false claims for federal incentives. Levinson noted that the agency plans to look for common issues across HHS programs “including issues related to information technology, cybersecurity, and the completeness, accuracy, and timeliness of data.”

RELATED: Audit estimates CMS issued hundreds of millions of dollars' worth of incorrect EHR incentive payments

The OIG’s emphasis on analytics maintains its ongoing effort to pair data with on-the-ground investigations. Earlier this year, OIG’s chief data officer credited the use of data analytics to tease out information that led to the arrest of nursing home tycoon Philip Esformes, who was charged with a $1 billion fraud scheme.

The Department of Justice has also placed more emphasis on analytics, announcing the creation of a new Opioid Fraud and Abuse Detection Unit that will use fraud data to prosecute individuals illegally distributing opioids. The new initiative builds on broader data-driven efforts that have “revolutionized” fraud prosecutions.