Ways To Improve HHS Inspector General's Operations and Relationship With FBI

GAO reviewed the investigative activities of the Office of the Inspector General (OIG) in the Department of Health and Human Services and its coordination with and relationship to the investigative activities of the Federal Bureau of Investigation (FBI). GAO also provided information on the involvement of the Health Care Financing Administration (HCFA) in referring potential Medicare fraud cases to OIG. GAO examined how carriers identify and prevent payment of unnecessary physicians' services and make recoveries where appropriate. GAO identified five areas in which OIG operations could be improved. Four of these problem areas exist in varying degrees at the seven different agency inspector general offices which GAO reviewed. GAO found that coordinating the development of the automated OIG management information system with other OIG's could improve the system and possibly save money. Sharing complete and timely information with the FBI could prevent duplicative investigative efforts and improve analysis of data on fraud cases. More thorough followup of case disposition and of recommendations for improved program control could better assure that fraud perpetrators are appropriately sanctioned and that needed program changes are made to prevent fraud from recurring. Clarifying the OIG investigative role could eliminate confusion and improve accountability and fraud control efforts. Changing the present system of referring potential fraud cases from carriers through the HCFA regional offices to OIG could facilitate the timely disposition of the cases and improve the carriers' chances to recover overpayments.