The following is a summary of the federal Health and Human Services agency’s Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country.[1] The enforcement actions reported are based upon federal and individual states’ activity.

The summaries reflect areas of OIG’s and individual states’ current and recent enforcement activity.[2] Knowing where regulators’ attention is focused can help healthcare providers identify areas of focus for compliance and risk assessment activities. Although not all the enforcement actions may be relevant to any one provider’s healthcare business, there may be some summaries that could be used as examples in compliance program education programs (“What to avoid”), or used in developing a risk management plan.

Of Note in this Issue:

1. New York Skilled Nursing Facility subject to a $7.85 Million Federal Court Stipulation and Order of Settlement and Dismissal when it changed its Medicare residents’ Medicare coverage from Medicare Advantage to Original Medicare. The Medicare Advantage disenrollment and Original Medicare enrollment was done without the residents’ knowledge, consent, or permission. (See June 29, 2022 summary)
2. COVID-19 fraud schemes that are prosecuted are increasing in being reported.
3. Telemedicine fraud schemes connected to issuance of prescriptions for DME or drugs are being reported.
4. Eight States' report on their settlements with Mallinckrodt Pharmaceutical related to Mallinckrodt's...

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