The Office of the Inspector General (OIG) at HHS expects to return over $1.5 billion to the federal government from healthcare fraud schemes investigated during the first half of the fiscal year, according to the agency’s spring report to Congress.
Audits conducted by the HHS watchdog between October 1, 2019, and March 31, 2020, also identified over $605 million in expected recoveries, as well as $288.4 million in questioned costs (i.e., costs questioned by OIG because of an alleged violation, costs not supported by adequate documentation, or the expenditure of funds where the intended purpose is unnecessary or unreasonable).
Overall, OIG told policymakers that HHS could save up to $911.3 million if the federal department implemented all of the OIG’s audit recommendations. During the reporting period, OIG made 273 audit and evaluation recommendations, of which HHS Operating Divisions implemented 130.
While these collection numbers seem impressive on the surface, it is estimated that there is over $800 billion lost to FWA in 2019, with this number expanding to over 1 trillion by 2024. Advanced AI systems such as the WhiteHatAI Centaur are crucial to handling the additional volume of FWA that is still slipping through the healthcare payer’s cracks, effectively addressing the hundreds of billions of dollars worth of health insurance FWA paid out annually.