Home Health & Hospice Week

Plus: Dirty OIG agent goes down.

It’s not always home health and hospice providers enduring all the feds’ scrutiny — even if it often feels like it.

The HHS Office of Inspector General is putting Medicare and Medicaid managed care organizations under their microscope. “The growth of managed care over the last several years has changed fundamental aspects of the Medicare and Medicaid programs. This significant shift transformed how the government pays for and covers health care for approximately 100 million enrollees,” the OIG says in a release.

In 2022, 50 percent of Medicare beneficiaries received care through Medicare Advantage, using 50 percent of the program’s spending, the OIG notes on its managed care featured topic webpage. And 81 percent of current Medicaid enrollees receive at least one component of care through managed care.

“The OIG has designated oversight of managed care as a priority area,” the watchdog agency says. “OIG has developed a strategy to align its audits, evaluations, investigations, and enforcement of managed care.”

More details of the OIG’s strategic plan for overseeing Medicare and Medicaid managed care organizations are at https://oig.hhs.gov/reports-and-publications/featured-topics/ managed-care.

And sometimes federal agents themselves are in the hot seat.

For example: A South Florida federal jury has convicted HHS OIG Special Agent Alberico Ahias Crespo of witness tampering and conspiracy to obstruct justice, the Department of Justice says in a release. Crespo worked as part of the South Florida Health Care Fraud Strike Force and prosecutors showed he used his position to protect and advance a multi-year Oxycodone trafficking scheme and impede related federal fraud investigations.

“Crespo betrayed the trust of the people he swore to serve, and … is seeing the consequences for his reprehensible actions,” the OIG’s Christian Schrank says in the release. “HHS OIG will not tolerate corruption within our ranks.”