Validation of the Health Care Related Convictions Attributed to the Office of Investigations of the Department of Health and Human Services

The Senate Committee on Finance requested that GAO evaluate certain information it had received on the Office of Investigations (OI), Office of Inspector General (OIG) of the Department of Health and Human Services (HHS). The information indicated that: (1) OI had exaggerated its effectiveness by claiming credit for convictions resulting from investigations carried out by others; and (2) OIG had done virtually nothing in following up on a September 1977 offer of assistance from a laboratory which was later a focal point of assistance to the Federal Bureau of Investigation (FBI) in its investigation and related convictions for Medicare-Medicaid fraud in Southern California. Because of time and staff constraints, GAO limited its efforts to validating the accuracy of the number of health care financing convictions attributed to OI in the 1978 and 1979 Annual Reports and to obtaining information on the extent of HHS follow up with the subject laboratory and the extent and nature of its interaction with the Department of Justice.

GAO found that: (1) the 1978 Annual Report identified 19 cases involving 31 convictions in 1978 under the category "Investigations Involving Medicare/Medicaid Investigations by the Office of Inspector General," of which 5 cases and 13 convictions were misclassified under this category; (2) eight Project Integrity I cases and five OI convictions were questionable attributions under the heading "Trends in OI Accomplishments" in the 1979 Annual Report; and (3) OIG made significant efforts to cooperate with the Department of Justice.