US health watchdog expects $5.56 billion in recoveries and savings

The Department of Health and Human Services watchdog expects $5.56 billion in recoveries and projected savings from October 1, 2025, through March 31, 2026, while barring 1,212 individuals and companies from federal programs. The latest semiannual report comes alongside a sharp drop in enforcement activity, with combined criminal and civil actions falling to 604 from 833 in the previous comparable period.

The office’s semiannual reports are required under the Inspector General Act of 1978 and cover the six-month periods ending March 31 and September 30. The latest report’s “total monetary impact” blends money actually recovered with savings expected from future actions. In this period, the office returned $12.70 for every dollar spent.

The Spring 2024 report identified more than $2.76 billion in expected recoveries, the Fall 2024 report put expected recoveries and receivables at $4.36 billion, and for the full 2024 fiscal year HHS-OIG said the total reached $7.13 billion, alongside 1,548 criminal and civil enforcement actions.

Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that they submitted invalid diagnosis codes for Medicare Advantage enrollees in order to secure higher government payments. An Arizona telemedicine software executive received a 15-year prison sentence and was ordered to pay more than $452 million in restitution for a fraud scheme that defrauded Medicare and other federal health benefit programs of more than $1 billion.

HHS-OIG says Medicare and Medicaid managed care now covers roughly 100 million enrollees. The office’s public enforcement page showed a May 22 notice expanding a Midwest task force and authorizing the hiring of 15 new Medicaid prosecutors.