Navigating the Latest OIG Semiannual Report: Key Takeaways for Healthcare Providers

The Department of Health and Human Services Office of Inspector General (OIG) recently released its Semiannual Report to Congress covering the period from April 1, 2025 to September 30, 2025. This comprehensive report provides vital insights into the OIG’s ongoing efforts to combat healthcare fraud and strengthen financial integrity — areas that every healthcare provider should understand and incorporate into their compliance strategies.

This report, issued on the heels of the Department of Justice’s announcement that it collected a record amount of False Claims Act penalties in FY2025, demonstrates that civil fraud enforcement — particularly in the healthcare field — continues to be a federal priority.

Several points in the OIG’s report are worth highlighting:

1. Impressive Return on Investment (ROI): The report cites a remarkable ROI in OIG efforts of $12.70 for every $1 spent. This high ROI continues to underscore the importance of enforcement efforts and the value of proactive compliance.

2. Utilization of Advanced Data Analytics: The OIG is leveraging sophisticated data analytics to identify and prevent fraud more efficiently. Notably, the report highlights significant increases in certain service categories:

• Skin Substitutes: Spending on skin substitutes has increased 640% over the past two years. It has long been clear that OIG would focus on this area, given the sheer amount of money involved. Upcoming payment scheme changes in 2026 will significantly reduce reimbursements for skin substitutes and put pressure on providers.
• Remote Patient Monitoring (RPM): A 31% growth from 2023 in Medicare payments for RPM highlights the expanding use of telehealth and remote care technologies. This area warrants close monitoring, as it will clearly be an area of interest for OIG in the future.

When OIG sees trends like this, providers can be sure that OIG investigators will keep a watchful eye on these products and services.

3. Enforcement Actions and Impact: The OIG’s enforcement efforts remain robust.

• 352 criminal actions and 481 civil actions were initiated.
• The 2025 National Healthcare Fraud Takedown initiative uncovered schemes involving:
  • DME: $10.6 billion
  • Diagnostic Testing: $1.84 billion
  • Telemedicine: $1.17 billion
  • Wound Care: $1.1 billion
  • Drug Diversion: $15 million
• Over 1,336 individuals and entities were excluded from federal healthcare programs. Individuals or entities that are excluded from participation in federal healthcare programs cannot receive payment from those programs for any services.
• Medicaid Fraud Control Units (MFCUs), state agencies investigating state Medicaid fraud in partnership with the OIG, achieved an ROI of $3.46 for every $1 spent.

The OIG makes clear that robust enforcement is here to stay, and providers should focus on the following points from this report:

• Data analytics continue to be a powerful enforcement tool. The government and its agencies are using data more efficiently and targeting high-risk activities. Providers should invest time in understanding their own data — including what it reveals about their operations — and how to leverage it for compliance and risk management.
• Proactive compliance programs are essential. Moving beyond mere regulatory checkboxes, a well-designed, implemented, and maintained compliance culture is critical. The ROI — though hard to quantify — is substantial, protecting your organization from costly penalties and reputational damage.
• Know your risks. Understand your organization’s risk tolerance and high-risk activities. Seek legal counsel and compliance advice early — don’t wait until a problem arises.
• Enforcement isn’t slowing down — and it will likely increase. Given the high ROI highlighted in this report, it’s clear that enforcement efforts will only intensify moving forward.

Providers with questions about healthcare enforcement or compliance strategies should contact Buchanan’s Healthcare attorneys for assistance navigating these complex issues.