The following is a summary of selected federal Department of Health and Human Services’ 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 reported by OIG through its listserv on Enforcement Actions.

The summaries reflect areas of OIG’s and individual states’ current and recent enforcement activity.[2] Knowing where regulators’ attention is focused help health care providers identify areas of attention for compliance and risk assessment activities. Although not all the enforcement actions may be relevant to any one provider’s health care 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. (Note: An Acronym Key appears at the end of the Report.)

Of Note in this Issue:

1. Cigna executes a five-year Corporate Integrity Agreement. (Corporate Integrity Agreement section below.)
2. Nurse practitioner convicted of Medicare fraud that included billing for more cancer genetic tests than any provider in the nation (including oncologists and geneticists) and for routinely billing Medicare for complex office visits that resulted in billings for over 24 hours in office visits in a single day. (September 22, 2023.)
3. New York physician treating nursing home patients for routine care, but billing at a critical care services level...

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