Get all your procedures in place to prevent trouble. As 2020 kicks off, PM practices find themselves in the crosshairs of the federal government’s fraud investigations for two very different services. All medical providers that report telemedicine services or prescribe opioids for pain management purposes are in the same boat, though, as the HHS Office of Inspector General (OIG) lists them both as top areas for fraud. Background: The OIG reports on fraudulent and abusive healthcare behavior that impacts federal healthcare programs in its Semiannual Report to Congress. Its most recent report focuses on incidents, enforcement, and takedowns from April 1, 2019 to Sept. 30, 2019. Opioid abuse, telemedicine fraud, and challenges with unaccompanied minors in HHS custody were among the OIG’s top issues during that time period, says Joanne M. Chiedi, acting HHS OIG inspector general. Statistics: During the report timeframe, Chiedi says OIG made great strides through audits, enforcement, and recoveries, working in tandem with its partners at the Department of Justice (DOJ), the Medicare Fraud Strike Force, State Medicaid Fraud Control Units, and other federal, state, and local law enforcement. Here’s a breakdown of the report numbers: Check Out These Top Cases The OIG oversees fraud and abuse that impact expenses and beneficiaries serviced by the Centers for Medicare & Medicaid Services (CMS). According to the report, OIG’s “largest body of work” includes investigating Medicare and Medicaid fraudsters. The investigations range from upcoding, billing for medically unnecessary or never performed services, opioid abuse and fraud, and kickbacks or bribes for referrals. Plus, organized crime surrounding federal healthcare programs is on the rise, too. “OIG also conducts investigations regarding organized criminal activity, including medical identity theft and fraudulent medical schemes established for the sole purpose of stealing Medicare dollars,” states the report. “Investigators are opening an increasing number of cases against healthcare providers who engage in these healthcare fraud schemes.” “Those who participate in the schemes may face heavy fines, jail time, and exclusion from participation in Federal health care programs,” OIG warns. Here are three of the biggest Medicare-related takedowns over the reporting period: Review the Semiannual Report to Congress at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2019/2019-fall-sar.pdf.