OIG Semiannual Report to Congress Shows 11:1 Return On Investment
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released its Semiannual Report to Congress summarizing program integrity efforts from October 2024 through March 2025 which showed a return of $11 for every $1 spent. The OIG is the lead federal agency combating healthcare fraud, waste, and abuse in federal programs such as Medicare, Medicaid and providers will likely see increased activity based on President Donald Trump’s goals to pay for the One Big Beautiful Bill Act.
OIG Highlights from October 1, 2024 – March 31, 2025:
- 78 reports issued
- 946 investigations closed
- 1,503 excluded individuals and entities
- 298 criminal informations and indictments (formal accusations)
- 1,209 referrals (to prosecutors)
- 349 criminal actions (convictions)
- 395 civil actions
OIG oversight impacting pharmacies includes:
- Medicare Part D improperly paid up to $465 million for drugs when payment was available under Medicare Part A over a 3-year period
- Medicare may have improperly paid up to $454 million for 39 million OTC COVID-19 tests in excess of the monthly limit of eight tests per enrollee
- Compounded prescriptions and HIV medications continue to be targets of FWA