HHS Inspector General Christi Grimm said her office has a "pressing need" for more funding to combat healthcare fraud, waste and abuse.
Ms. Grimm said in written testimony submitted to the House Subcommittee on Oversight and Investigations that President Biden's fiscal year 2025 budget request contains a legislative proposal that, if enacted, would enable the office and its partners to "to ramp up fraud-fighting and other critical program integrity activities."
She said the office needs more agents and digital evidence experts to work fraud cases. It also needs auditors, data scientists and analysts to detect improper payments, trends outliers and program vulnerabilities, and to recommend solutions.
"Despite our extensive reviews and enforcement, our limited resources do not allow us to provide the level of comprehensive oversight of Medicare and Medicaid that is needed and should be expected by the American public," Ms. Grimm said.
She said that her office makes tough choices every day on which cases and issues to decline for lack of resources. The office has been turning down between 300 and 400 viable criminal and civil healthcare fraud cases every year. Additionally, they've been turning down more than half of the referrals of potential fraud CMS contractors make as part of the OIG's major case coordination effort with CMS.
"Uninvestigated cases represent real, potential unchecked fraud; the potential for patients to be put in harm’s way; and missed opportunities for deterrence and monetary recoveries," Ms. Grimm said.
The office reviewed and evaluated more than 2,698 hotline complaints in 2022 and more than 4,501 complaints in 2023 that might have developed into viable cases, but it lacked the resources to follow up, she said.
"I do not want to leave a misimpression that we are not addressing serious fraud and abuse. We are, and our statistics and return on investment show it," she said. "We take a data-driven, risk-based approach to address the most egregious cases of harm and abuse to hold bad actors accountable, protect people, and identify misspent funds and potential savings. However, with current resources, we cannot keep up with the level of threat to HHS, patients, and taxpayer dollars."