Latest news with #OIG
a day ago
- Business
Democrats accuse McMahon of stonewalling Department of Education IG
Congressional Democrats are demanding that Department of Education Secretary Linda McMahon cooperate with the agency's Office of Inspector General review of the Trump administration's efforts to overhaul the agency. In a letter first obtained by ABC News, a group of Democrats on the Education, Oversight, Homeland Security and Governmental Affairs, and Appropriations committees in the House and Senate sent the secretary a letter accusing her of stonewalling the agency's inspectors general. "The OIG must be allowed to do its job,' they wrote. 'We urge the Department to immediately meet its obligation under the law to fully comply with the OIG's review,' the letter said. 'Congress and the public need to understand the full extent and impact of the Administration's actions on the Department and the students, families, and educational communities it may no longer be able to serve." ABC News reached out for comment from the Department of Education on the allegations but did not receive an immediate reply. McMahon will face these questions in person when she testifies before the House Education and Workforce Committee on Wednesday. The letter stems from what McMahon calls her 'final mission' as the 13th education secretary to shutter the department, and the administration's first steps to diminish the agency through a reduction in force that slashed nearly half its staff in early March. The lawmakers are requesting a response no later than Friday. After several attempts to conduct its review over the last two months, an OIG letter said the prolonged had resulted in 'unreasonable denials' and 'repeated delays' to its work. According to a recent OIG letter sent to the House and Senate committee members, the Education Department blocked it from 'timely access to all records, reports, audits, reviews, documents, papers, recommendations, or other materials available to the department.' House Education and Workforce Committee ranking Democrat Bobby Scott told ABC News, 'I think the fact that they have indicated that there is a lack of cooperation ought to be concerning to people when inspectors general can't do their jobs.' The OIG contends its 'statutory mission' to oversee the changes at the department under the Inspector General Act have been impeded. 'Our review has been delayed by the refusal of the Department to provide the OIG with a majority of the information and documents requested or direct access to staff for interviews,' acting Inspector General René L. Rocque wrote last month in a letter fulfilling her dual reporting requirement. The department has canceled scheduled OIG interviews with its staff and insists that an Office of the General Counsel lawyer be present for any rescheduled interviews, according to the OIG. The OIG alleges those requests from the department are unprecedented and contrary to the OIG's longstanding practice. The OIG office is the statutory, independent entity within the department responsible for identifying fraud, waste, abuse and criminal activity involving department funds, programs, and operations, according to its website. By denying the federal watchdog access to the department's records, the lawmakers believe McMahon is failing to meet her obligation as an agency head. There is no basis to withhold department documents from the OIG regardless of the privileged nature of the information or if it's subject to litigation, the OIG said. The news comes as McMahon testifies before Congress on the agency's priorities and policies, specifically calling for a $12 billion cut to education under President Donald Trump's fiscal year 2026 budget outline. McMahon has stressed she will continue all statutory functions of the agency and work to abolish it in a 'lawful fashion.' Ahead of his committee's hearing with McMahon, Scott said, 'We hear all these pronouncements about what's going to happen. What is the plan? They've acknowledged they can't get rid of the Department of Education without legislation. Are they supporting legislation?' Democrats, including Scott, have decried the administration's work force reductions, particularly the impact the layoffs could pose to the department's critical responsibilities such as administering Federal Student Aid services and ensuring students' civil rights. Their three-page letter to McMahon claims states have experienced delays in accessing relevant portals to receive federal funding, college financial aid advisors have experienced significant delays in getting answers from FSA personnel, parents with pending Office for Civil Rights OCR cases have been left in the dark. 'When they have all these cases of discrimination in the Office for Civil Rights enforcing Title VI, including anti semitism, how is the job going to get done if you fired most of the staff in the Office of Civil Rights?' Scott said. 'If the inspector general can't get an answer, then oversight is lost,' he added.
Yahoo
2 days ago
- Business
- Yahoo
Walnut Hill Study Exposes Systemic Medicare Advantage Barriers Causing Delays, Denials, and Patient Abandonment
DALLAS, June 3, 2025 /PRNewswire/ -- Walnut Hill Medical has released findings from its MAD (Medicare Advantage Denial) Study, revealing that Medicare Advantage plans are systematically delaying or denying access to a non-opioid, non-steroidal chronic pain treatment: Peripheral Nerve Stimulation (PNS). Based on a proprietary dataset of 1,210 Medicare Advantage patients who sought prior authorization for PNS in 2024, the study paints a troubling picture—raising urgent concerns about transparency, equity, and access in America's most popular form of Medicare coverage. "Prior authorization isn't just a bureaucratic hurdle—it's being weaponized to deter care," said Chris Hanna, CEO of Walnut Hill Medical. "Transparency is the first step toward accountability." Understanding the Issue: What Is Medicare Advantage and Prior Authorization? Medicare Advantage (Medicare Part C) is a private alternative to traditional Medicare, now covering over half of all Medicare beneficiaries. These plans are managed by private insurers and often tout extra benefits—but they also impose stricter controls, including prior authorization (PA) requirements for many medical services. Prior authorization requires providers to obtain insurer approval before delivering care. While designed to ensure medical necessity and control costs, PA can also result in significant care delays—or outright denials. The 2022 Warning That Went Unheeded In 2022, the Office of Inspector General (OIG) found that 13% of denied services in Medicare Advantage met Medicare coverage criteria and should have been approved. The OIG warned that plans may be inappropriately restricting access to necessary care. Walnut Hill's 2024 data show the problem is even worse—especially for patients seeking advanced therapies like PNS. Key Findings: Denials, Drop-Off, and Delays in Pain Treatment Access PNS is a minimally invasive, FDA-cleared therapy for chronic pain. Walnut Hill's study found: 29% of patients were denied on their first prior authorization attempt—more than twice the OIG's 2022 benchmark. 28% of patients abandoned care after an initial denial—never appealing or resubmitting. Among those who appealed: 56% had their denial overturned. 69% who escalated to a Medicare hearing (OMHA) were approved. "This isn't just inefficiency," Hanna said. "It's a sorting mechanism that weeds out patients without time, resources, or strong clinical advocates." The Cost of Denial: Financial Incentives and Patient Harm Of the 1,210 patients studied, 210 were denied and never received their PNS therapy. Based on 2024 Medicare Advantage reimbursement rates, Medicare Advantage plans withheld $6.2 million worth of care from patients—highlighting how administrative attrition reduces cost at the patient's expense. A Call for Oversight and Reform "Medicare Advantage now covers the majority of eligible seniors," said Hanna. "With that dominance must come responsibility. Our data show that without reform, prior authorization becomes a silent gatekeeper—not just delaying care but denying it altogether." Walnut Hill is urging lawmakers to strengthen transparency and accountability provisions in the bipartisan Improving Seniors' Timely Access to Care Act of 2025, introduced by Rep. Mike Kelly (R-PA). Download the Full Report The complete MAD Study, including detailed methodology, statistics, and patient-level analysis, is available here: About Walnut Hill Medical Walnut Hill Medical partners with medical device companies, providers, life sciences organizations, and patients to deliver expert reimbursement strategy, health policy insights, and seamless prior authorization support. Their mission: Empower innovators to deliver care, enable doctors to focus on patients, and help patients access the therapies they need—without administrative barriers. Resources: Walnut Hill Medical MAD Study: Full OIG Report: Improving Seniors' Timely Access to Care Act of 2025: Media Contact:Grace CuillierDirector of StrategyGCuillier@ View original content to download multimedia: SOURCE Walnut Hill Medical Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Axios
4 days ago
- Business
- Axios
Exclusive: HHS watchdog finds more than $16B in health savings
The Department of Health and Human Services' watchdog identified more than $16 billion in overpayments, fraudulent billings and possible cost savings in health programs over a half year spanning the Biden and Trump administrations, including more than $3.5 billion to be returned to the government. Why it matters: The semiannual summary, first shared publicly to Axios, comes as the Trump administration says it's prioritizing government efficiency and rooting out waste, fraud and abuse. It reflects growing concern over federal payments to Medicare Advantage plans, along with enforcement actions like McKinsey agreeing to pay $650 million to settle charges that its advice caused Purdue Pharma to submit fraudulent claims stemming from the opioid crisis. The report was sent to Congress late Friday. By the numbers: The HHS Office of Inspector General identified $16.6 billion in real and potential savings from October 2024 through March of this year. The office's investigations identified $3.5 billion in funds due back to the federal government, and its audits found another $451 million that the government will recoup. More than $12 billion in potential cost savings were identified if HHS makes recommended policy changes. The office issued 165 recommendations over the six months. In one example, OIG found that Medicare could have saved $7.7 billion if it lowered payments for swing beds at critical access hospitals so that they match skilled nursing facilities. The change would require action from Congress, and the Centers for Medicare and Medicaid Services said it didn't agree with the recommendation. Nearly 400 civil actions, including settlements, resulted from OIG's work during the period. OIG says its work returned $11 to the federal government for each $1 invested in its office. "Whether it's us, whether it's [the Government Accountability Office], whether it's DOGE, whether it's state auditors, there's always a need for program integrity and oversight," said John Hagg, assistant inspector general in the IG's office of audit services. Zoom in: OIG over the six months covered in the report continued its investigations that raise concerns over improper payments in Medicare Advantage. OIG found that many patient diagnoses reported by privately run Medicare plans were supported only through health risk assessments. That allowed plans to be paid more to care for sicker, more expensive patients without enough supporting documentation, raising questions about their validity, per OIG. OIG recommended that Medicare further restrict plans' abilities to get higher payments based on diagnoses reported only on in-home health risk assessments in order to save an estimated $4.2 billion for Medicare. The office plans to do more work on Medicare Advantage in the near future, Melicia Seay, assistant inspector general in the office of evaluation and inspection, told Axios. "There's a lot of areas in terms of Medicare Advantage that we're exploring, whether it is the payment policy related to the program, the service delivery, quality of care," she said. Catch up quick: President Trump in January abruptly fired several agency inspectors general, including longtime HHS watchdog Christi Grimm. He claimed that"some were not doing their job."
Yahoo
27-05-2025
- Health
- Yahoo
Veteran Affairs Office of Inspector General releases inspection report on Augusta's VA
AUGUSTA, Ga. (WJBF) – The Department of Veterans Affairs Office of Inspector General released a report of its inspection results for the VA Augusta Health Care System this month. The report, entitled Healthcare Facility Inspection of the VA Augusta Health Care System in Georgia, was published on May 22, 2025. According to the report summary, the evaluation focused on five key content domains: Culture Environment of care Patient safety Primary care Veteran-centered safety net The OIG issued five recommendations for improvement in Culture, Environment of care and Patient Safety areas. The report in its entirety can be read here: vaoig-24-00617-118Download Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
26-05-2025
- Business
- Yahoo
Opinion: The Tools DOGE Needs to Succeed Are Already in Government. I Should Know.
The fight against fraud 'is a long-term enterprise,' Elon Musk said recently. 'If we take our eye off the ball, the waste and fraud will come roaring back,' he added. And a recent report summary released by Amtrak's Office of Inspector General (OIG) shows just how loud fraud can roar. The OIG's report revealed the largest criminal conspiracy in Amtrak's history—a widespread, years-long scheme in which at least 119 Amtrak employees conspired with healthcare providers to bilk Amtrak's health care plan of more than $12 million over just three years. According to the Amtrak OIG, the employees accepted thousands of dollars in cash kickbacks so the healthcare providers could use their insurance information to file fraudulent and questionable medical claims for services that were never provided or not medically necessary. A dozen perpetrators, including eight Amtrak employees and four medical professionals, have already been convicted, with restitution amounting to millions of dollars and counting. (One acupuncturist caught in an undercover sting must pay back more than $9 million alone.) The OIG also referred a whopping 61 active employees for personnel action. The report is a timely reminder of why we need Inspectors General. They provide crucial oversight of our federal tax dollars, to prevent and detect waste, fraud, and abuse throughout the government. They are uniquely situated to not only investigate misconduct, but also make recommendations on how their agencies can improve—and hold them accountable for failing to implement recommended changes. It's also important to highlight how the OIG uncovered the Amtrak scheme in the first place: data analysis. 'The investigation was sparked,' according to the OIG's summary, 'when an OIG agent noticed unusual billing patterns in reports.' Bolstering data analytics has been a focal point for the Inspector General community for years. And this investigation is a good illustration of the future of IG oversight: harvesting the government's huge streams of data to find anomalies and patterns that indicate suspicious behavior. During the Covid-19 pandemic, for example, Inspector Generals used data to uncover billions of dollars in waste, fraud, and abuse in pandemic spending across federal agencies. Americans should expect to see more data-based oversight in the future and that's a good thing. Crucially, this could inform the future of Musk's DOGE, the Department of Government Efficiency. As Musk's tenure at the department apparently winds down in the coming weeks, the question becomes what it will look like without—or beyond—him. Some have suggested that DOGE's high-powered techies should focus their efforts on analyzing huge federal data sets. If DOGE reframes in that way—shifting from Musk's chainsaw, cut-everything-in-sight campaign to a more surgical, sustainable approach—the IG community should be a natural ally and asset in improving the performance of federal agencies for the benefit of the American people. But this would require a few changes. First, a mindset shift in DOGE, which has seemingly sidelined the OIGs. Second, President Trump would have to nominate nonpartisan, independent IGs who will have the requisite credibility to effect positive change in their agencies—and empower them to do their jobs without fear of retribution. There are currently an astounding 28 vacant IG positions for the President to appoint, many due to the fact that he fired 18 IGs—myself included— at the start of his term due to 'changing priorities.' Moving forward in this vein, Trump must issue a clear and unequivocal statement affirming the OIG community's authority to carry out independent oversight, including reaching conclusions that may not align with his preferences. With these changes, the Inspector General community could become an effective partner and force multiplier for DOGE 2.0 in preventing waste and fraud from roaring back.
