The Office of Inspector General is recovering less money from fraud investigations, but the agency is clearly shifting its focus toward civil actions, according to information included in the OIG's Semiannual Report to Congress.
The OIG recovered nearly $3.35 billion in fiscal year 2015, including $2.2 billion in investigative receivables. That's almost half of what the OIG recovered last year ($4.1 billion) and nearly a third of what it recovered in FY 2012 ($6 billion).
However, the OIG continues to see a gradual increase in civil actions, including false claims lawsuits, civil monetary penalty (CMP) settlements and administrative recoveries tied to provider self-disclosure matters. Civil actions have more than doubled in the past four years, reaching 682 in FY 2015. Criminal actions have declined slightly, dropping from 971 last year to 925 this year.
In June, the OIG announced a new litigation team that will focus specifically on CMPs and exclusion cases, which some see as a new avenue for government enforcement. The OIG previously reported that it resolved 110 CMP cases in 2015, and officials expect that upward trend to continue.
The Medicare Fraud Strike Force continues to play a key role in fraud enforcement, particularly following June's historic fraud bust. The Strike Force contributed to 225 criminal actions in 2015, down slightly from 232 last year. Those actions contributed $357 million in investigative receivables, down from last year's unusually high numbers, but a marginal increase from 2013.
- read the OIG's Semiannual Report to Congress
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