Office of the Secretary, Office of Inspector General (OIG)
The mission of the Office of Inspector General is to protect the integrity of Department of Health and Human Services programs as well as the health and welfare of the people they serve.
OIG Budget Overview
(Dollars in millions)
|Discretionary Appropriation /2||77||76||68||-8|
|Health Care Fraud and Abuse Control Program (HCFAC)||11||11||12||+1|
|Total Funding, All Sources||343||341||359||+18|
1/ Reflects the annualized level of the Continuing Resolution that ended April 28, 2017, including the across the board reduction, the 21st Century Cures Act, and directed transfers.
2/ Includes the $1.5 million permissive transfer from the Food and Drug Administration appropriation in FY 2016 and FY 2017.
The President’s fiscal year (FY) 2018 Budget requests $359 million for the Office of Inspector General (OIG), an increase of $18 million above the FY 2017 Continuing Resolution. These funds will enable OIG to target oversight efforts and ensure efficient and effective use of resources within the programs.
OIG’s areas of oversight fall into two broad categories: Public Health and Human Services Oversight and Medicare and Medicaid Oversight.
Public Health and Human Services Oversight
OIG uses funding from its discretionary budget authority to conduct program integrity and enforcement activities for HHS programs and operations. OIG will continue to review activities for any evidence of fraud, waste, and abuse and oversee new and emerging issues related to HHS’s international and domestic response to public health concerns and new cyber security threats facing the Department.
The FY 2018 Budget request for Public Health and Human Services Oversight is $68 million, which will support the following investments to strengthen the integrity of HHS programs including:
- Protecting HHS Grants from Fraud, Waste and Abuse: OIG will continue focus on grant oversight efforts on high risk grant programs, including grants for services to children and substance abuse grant funding provided under the 21st Century Cures Act for opioid abuse prevention and treatment programs.
- Oversight of Indian Health Services: OIG will continue oversight of quality of care and program administration.
- Public Health Emergencies: OIG will continue oversight of HHS grants for emergency preparedness and provide training and education to promote preparedness and prevent fraud, waste, and abuse.
- Ensuring Privacy and Security Information: OIG will work to increase oversight and investigative response to threats from computer hacking groups intent on compromising systems and releasing sensitive data. OIG conducts general security control audits of information and technology supporting HHS programs and conducts network and web application penetration testing to assess HHS’s network security to determine vulnerability.
Medicare and Medicaid Oversight
Through its multi‑disciplinary oversight work, OIG saves taxpayer dollars and works to ensure that patients receive medically appropriate care in the Nation’s largest health care programs—Medicare and Medicaid. OIG relies on principles of prevention, detection, and enforcement to address fraud, waste, and abuse in these programs. Two key focus areas are sound fiscal management of the programs and ensuring that beneficiaries have access to quality care in the right setting as determined by the beneficiary and his or her medical providers.
OIG protects these programs and their beneficiaries using a multidisciplinary approach and through important partnerships, including with the Department of Justice and State Medicaid Fraud Control Units. Fraudulent providers often cheat both Medicare and Medicaid (and their beneficiaries), and thus OIG fraud‑fighting and patient protection activities often have cross-cutting impacts. The Health Insurance Portability and Accountability Act (HIPAA) established the HCFAC Program to combat fraud, waste, and abuse in health care. The funds OIG receives under HIPAA are dedicated to activities relating to Medicare and Medicaid. Overall, HCFAC funding constitutes the major portion of OIG’s annual operating budget.
The FY 2018 Budget request for OIG includes $290.7 million for Medicare and Medicaid oversight, an increase of $26.4 million over the FY 2017 Continuing Resolution.
The FY 2018 Budget supports the Administration’s priorities of addressing fraud, waste, and abuse in Federal health care programs and strengthening the fight against opioid abuse in this country. OIG’s work reflects issues of access and affordability, increased Medicare and Medicaid enrollment and spending, innovations in health care and data analytics, quality of care, and the increase in complexity and technical sophistication of fraud schemes. OIG will continue its work from FY 2017 to address fraud, waste, and abuse in prescription drugs, including abuse and diversion of opioids.
Prescription Drug Abuse and Fraud Prevention Authorities
Opioid abuse and abuse of prescriptions for non‑controlled potentiator drugs that enhance the euphoric effects of opioids endanger patients, communities, and taxpayer dollars.
OIG uses its legal authorities including law enforcement authorities, data analytics, investigation, audit, and evaluation capabilities, to strengthen the Administration’s fight against opioid abuse. OIG addresses prescription drug fraud along the entire supply chain, from manufacturers who make and promote products to physicians and pharmacies.
Additional HCFAC funding will provide OIG with resources to increase investigations into fraudulent prescribing and dispensing of opioids, including forensic accounting and medical record reviews to increase the number of investigated cases and their expedient investigation and prosecution. OIG will further enhance its data analytics capabilities for identifying aberrant opioid prescribing or dispensing patterns and target interventions to combat prescription drug abuse.