Testimony Before the  
United States House Committee on Energy and Commerce 
Subcommittee on Oversight and Investigations 
 
 
 
 
Insights From the HHS Inspector General on  
Oversight of Unaccompanied Minors,  
Grant Management, and CMS 
 
Testimony of: 
Christi A. Grimm 
Inspector General  
Department of Health and Human Services 
 
 
 
 
 
April 18, 2023 
10:30 a.m. 
2322 Rayburn House Office Building Testimony of: Christi A. Grimm 
Inspector General 
             Department of Health and Human Services 
 
Good morning, Chairman Griffith, Ranking Member Castor, and distinguished Members of the 
Subcommittee.  I am Christi A. Grimm, Inspector General of the Department of Health and 
Human Services (HHS).  Thank you for inviting me to testify today regarding insights from our 
oversight of HHSs Unaccompanied Children (UC) Program, grants management with a focus on 
National Institutes of Health (NIH) grants, and the Centers for Medicare & Medicaid Services 
(CMS), including unwinding the COVID-19 public health emergency (PHE). 
INTRODUCTION 
The Office of Inspector General at HHS (HHS-OIG) is at the forefront of the Nations efforts to 
fight fraud, waste, and abuse.  We provide independent, objective, evidence-based oversight and 
conduct criminal, civil, and administrative investigations of fraud and misconduct to protect and 
strengthen HHS programs.  As mandated by the Inspector General Act, HHS-OIGs nearly 1,600 
dedicated professionals are laser focused on preventing and detecting fraud, waste, and abuse, 
and promoting the economy, efficiency, and effectiveness of HHSs more than 100 health and 
human services programs.   
HHS-OIGs oversight portfolio is vital, vast, and varied.  In fiscal year (FY) 2022, HHS-OIG 
was responsible for oversight of more than $2.4 trillion in HHS expenditures.  HHS is the 
Federal Governments largest grant-making agency and the fourth largest contracting agency, 
with obligations of $126.6 billion in non-CMS grants ($740.3 billion in total grants including 
CMS) and $38.9 billion in total contracts obligated in FY 2022.  With a FY 2023 enacted budget 
of $432.5 million, OIG has about 2 cents to oversee every $100 of HHS spending.  Of note, from 
2020 through 2022, HHS was appropriated more than $462 billion for COVID-19 pandemic 
response programs, including $186.5 billion for the Provider Relief Fund.  HHS-OIG received 
$19 million in supplemental funding to oversee these funds. 
HHSs wide-ranging programs provide health insurance for seniors, disabled persons, and low-
income individuals and families; operate and subsidize private market health insurance; support 
public health; respond to emergencies; protect the safety of food and medical products; promote 
the well-being of children and other vulnerable populations; provide health care to American 
Indians and Alaska Natives; address mental health; combat substance abuse; and fund medical 
research, among other activities.  OIGs oversight is meant to protect these HHS programs that 
touch the lives of virtually every American.  
Through independence, objectivity, and transparency, and by holding wrongdoers accountable, 
HHS-OIGs mission-critical work helps ensure that HHS programs better serve the American 
people and that taxpayer dollars are properly spent.  OIGs data-driven findings and actionable 
recommendations help ensure that HHS programs effectively and efficiently achieve their goals 
for the people they serve and deliver value to taxpayers.  
OIGs statistical accomplishments and return on investment provide a snapshot of our work in 
preventing, detecting, and combating fraud, waste, and abuse.  In FY 2022, HHS-OIGs work 
resulted in approximately $2.7 billion in expected investigative recoveries and 1,446 criminal 
and civil actions.  HHS-OIG excluded 2,332 untrustworthy individuals and entities from   
participation in Federal health care programs, including those convicted of patient abuse, neglect, 
and fraud.  We issued more than 150 reports that included 445 new recommendations to 
strengthen HHS programs.  Last year, our audit work identified nearly $1.2 billion in expected 
recoveries as well as nearly $2.2 billion in questioned costs.  HHS operating divisions 
implemented 424 prior recommendations.  HHS-OIGs work consistently yields a positive health 
care return on investment of around $11 returned to every $1 invested, including expected and 
actual recoveries of funds to HHS programs. 
My testimony will focus on the three important topics about which you have invited me to 
testify: unaccompanied minors (also known as unaccompanied children); grants management, 
with a focus on NIH grants; and CMS, including unwinding of the COVID-19 PHE.   
KEEPING CHILDREN SAFE: UNACCOMPANIED CHILDREN 
Overview of OIG Oversight of the Unaccompanied Children Program 
OIGs oversight of the UC Program is part of our commitment to keeping children safe across 
HHS programs, including Medicaid, Foster Care, the Childcare Development Fund, and Head 
Start.  The UC Program, which is run by the Administration for Children and Families (ACFs) 
Office of Refugee Resettlement (ORR) within HHS, is charged with caring for minors who have 
no lawful immigration status in the United States and do not have a parent or legal guardian 
available to provide care and physical custody. 
To help ensure that the UC Program keeps unaccompanied children safe and provides required 
services, OIG has conducted expansive oversight of the UC Program since responsibility for 
caring for unaccompanied children was transferred to HHS by the Homeland Security Act of 
2002.  In the past 6 years, we have produced 27 reports and 1 toolkit, based on site visits to 
ORR-funded care provider facilities, interviews with staff from those facilities and HHS, and 
reviews of HHS documents and systems, including ORRs case management system, known as 
the UC Portal. 
As our oversight work demonstrates, caring for fluctuating numbers of children entering the UC 
Program has been a continuing challenge for HHS.  Key findings and recommendations from our 
body of work have highlighted, for example, the need for improving interagency communication 
and coordination to better prepare for taking unaccompanied children into HHS custody; better 
planning for sufficient bed capacity; and improved management of influx care facilities and 
emergency intake facilities.  In May 2021, we published a toolkit1 summarizing key risk areas 
that require HHSs attention and outlining consequential actions that HHS can take to better 
ensure the health and safety of unaccompanied children in its care. 
Our work has identified concerns with hiring and screening facility employees; ensuring facility 
safety and security; and reporting and tracking significant incidents.  Moreover, our past work 
has underscored the need for HHS to be prepared to address the medical and mental health needs 
of unaccompanied children.   
 
1 Toolkit: Insights From OIGs Work on the Office of Refugee Resettlements Efforts To Care for Unaccompanied 
Children, May 2021, OEI-21-00220.  Available at https://oig.hhs.gov/oei/reports/OEI-09-21-00220.pdf. 
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In addition, OIG has key law enforcement functions related to the UC Program.  We receive and 
review certain allegations related to the safety of children in ORRs care and custody.  We work 
closely with State and local law enforcement, as well as Federal partners when warranted. 
OIG Review of the Emergency Intake Site at Fort Bliss 
In September 2022, we published a report, Operational Challenges Within ORR and the ORR 
Emergency Intake Site at Fort Bliss Hindered Case Management for Children.  This report 
focused specifically on the Fort Bliss emergency intake site (EIS), one of 14 EISs established by 
ORR between March 2021 and May 2021 in response to a severe shortage of beds in ORRs 
licensed care provider network and influx care facilities.  This review focused specifically on the 
provision of case management services, given the concerns raised by ORR staff, child welfare 
agencies, and members of Congress.  
Our report found that from the opening of the EIS at Fort Bliss in March 2021 through June 
2021, operational challenges within ORR and at the Fort Bliss EIS hindered case management, 
raising concerns related to childrens safety and well-being.  First, ORR and facility staff 
reported that the rushed opening of the Fort Bliss EIS impeded ORRs ability to bring in 
experienced case managers and provide them with adequate and timely training.   
Second, we identified concerns related to the safe release of children.  Specifically, ORR issued 
guidance to expedite childrens release, which removed several safeguards from ORRs process 
for screening potential sponsors.  For example, for sponsors who are an unaccompanied childs 
parent, guardian, or close relative, guidance eliminated the need to conduct background checks 
of sponsors adult household members.  Although the purpose of the guidance was to reduce 
delays, the removal of these safeguards may have increased childrens risk of release to unsafe 
sponsors.  As noted in the report, although ORR must ensure that children do not experience 
unnecessary delays in release, it must also ensure that children are safely released to thoroughly 
vetted sponsors.  Further, we noted that deficiencies with ORRs online case management 
systemthe UC Portalcontributed to case management delays and potentially increased 
childrens risk of release to unsafe sponsors.  Finally, we heard from staff that they were reticent 
to report problems for fear of retaliation.   
We recommended that ACF assist ORR in taking a range of actions, including securing qualified 
case managers during an influx, providing case managers with timely and comprehensive 
training and support, and creating an emergency policy development protocol that provides for 
adequate staff input.  ACF concurred with our recommendations. 
However, much more remains to be done to protect children in the UC Program, which is why 
oversight of the UC Program is a continuing priority for HHS-OIG.  We have work underway 
examining sponsor screening in greater depth.  We also have ongoing work looking at ACFs 
awarding and monitoring of contracts, employee background checks, facility placements and 
transfers, and cybersecurity controls to protect the UC Portal.  We remain steadfast in our 
dedication to doing all we can to ensure that UC Program is operating as intended and with the 
best interests of children at the forefront. 
PROTECTING TAXPAYER INVESTMENTS: GRANTS MANAGEMENT 
Overview of OIG Oversight of Grants Management 
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HHS is the largest grant-making agency in the United States.  OIG oversight helps ensure that 
the substantial amount of taxpayer dollars awarded through HHS grants is used in accordance 
with Federal requirements and that HHS programs effectively and efficiently serve the people 
who depend on them.  OIG has identified risks to HHS grants, including fraud, unallowable costs 
charged to HHS programs, and inadequate systems of internal control to provide reasonable 
assurance that the grant recipient is managing the award in compliance Federal requirements.  
Fraud is intentional deception for personal gain or to cause harm.  In grant programs, fraudsters 
may lie, cheat, and steal.  For example, fraudsters may falsify information in award applications, 
lie about the work they performed, or misuse grant funding.  Grant fraud can be hard to identify 
for a multitude of reasons, including that fraudsters scheme to keep their actions undetected, 
fraud schemes can be complex and difficult to unravel, and grants are usually governed by 
complex terms and conditions.  
Effectively fighting grant fraud requires sustained resources focused on preventing problems 
from occurring in the first place, detecting problems promptly when they occur, and rapidly 
remediating detected problems through investigations, enforcement, and corrective actions.  In 
coordination with the Department of Justice and HHS, as appropriate, OIG pursues criminal 
actions, civil fraud remedies, and administrative actions to combat misuse of grant funds, help 
restore stolen funding, prevent bad actors from continuing harm, and deter future fraud.   
Unallowable costs are costs that do not comply with regulations or are excessive, unreasonable, 
or unsupported.  Across our work, OIG has commonly identified unallowable charges to HHS 
grants for salary, travel, donations, supplies, construction and renovation, and rent.  In addition, 
HHS recipients have improperly used funds to pay for expenditures unrelated to the grant or for 
personal purposes.  We have found that some grant recipients lack robust financial management 
systems, did not always adhere to Federal requirements, and did not maintain adequate 
documentation of expenditures.  OIG has also identified deficiencies in internal controls at the 
recipient level (e.g., ensuring that grant costs are supported by documentation) and the operating 
division level (e.g., timely grant closeout).  
 
Identifying and referring bad actors for suspension and debarment when appropriate is an 
important tool for sound grants management.  If bad actors and poor performers are not 
prevented from receiving additional Federal awards in a timely manner, beneficiaries of grant 
and other programs may suffer, and taxpayer funds may be misused.  A January 2022 OIG 
evaluation highlighted the importance of the suspension and debarment program to protect 
Federal programs and funds but identified opportunities to improve the timeliness, efficiency, 
and effectiveness of the program.2  Two recommendations from this report remain open related 
to improving case management and tracking of referrals and ensuring more consistent senior 
leadership and sufficient staffing. 
 
Oversight of National Institutes of Health Grants Management 
 
 
2 HHSs Suspension and Debarment Program Helped Safeguard Federal Funding, But Opportunities for 
Improvement Exist, OEI-04-19-00570, January 2022.  Available at https://oig.hhs.gov/oei/reports/OEI-04-19-
00570.pdf. 
  
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Since 2019, OIG has increased its oversight of NIH using supplemental funding that Congress 
has provided specifically to oversee NIH grant programs and operations.  HHS-OIG has 
conducted, and continues to conduct, extensive oversight of NIH programs, with reviews focused 
on NIHs management of grants, contracts, and operations; award recipients compliance with 
Federal requirements; and cybersecurity protections.  Our work has highlighted how NIH can 
make progress by improving fundamental aspects of its grants programs and operations that any 
grant-making agency should strive to get right.   
 
For example, a recent report that examined monitoring of grants at the NIH and EcoHealth 
Alliance found that NIH did not exercise rigorous oversight over potentially high-risk research.. 
Our January 2023 report, The National Institutes of Health and EcoHealth Alliance Did Not 
Effectively Monitor Awards and Subawards, Resulting in Missed Opportunities To Oversee 
Research and Other Deficiencies, builds on a larger body of work examining NIHs oversight 
and monitoring of recipients to ensure that grant funds are appropriately used and managed.  
Although the type of research and related issues raised by the EcoHealth Alliance grants are 
complex, many of our findings are about common failures of routine grant oversight, such as 
failing to follow up on progress reports.  
 
I want to be very clear that our report was not designed to determine whether the research 
conducted by EcoHealth Alliance, or its subrecipients, involved gain-of-function or led to 
enhanced potential pandemic pathogens (ePPPs).  In addition, our report was not designed 
address the origins of the COVID-19 virus.  Rather, it examined whether and how NIH and 
EcoHealth Alliance performed essential grants oversight.     
Our report found that although NIH established some guardrails, they were not always used 
effectively to oversee its award to EcoHealth Alliance.  We further found that although NIH 
raised concerns with EcoHealth Alliance that its research could result in the use or creation of 
certain risky pathogens, NIH did not follow through with better oversight.  NIH did not 
effectively use routine tools, such as annual progress reports, to monitor EcoHealth Alliance.  
Using its policy discretion, none of EcoHealth Alliances awards were referred under the 
Departments HHS P3CO Framework3 specifically established to review research for ePPPs.  
NIH determined that EcoHealth Alliances proposed research did not meet specific scientific 
definitions that required further review by the Department.   
 
In the case of the EcoHealth Alliance grants, NIH took at least one step to implement enhanced 
oversight.  NIH required EcoHealth Alliance to notify NIH immediately of certain research 
results that might have triggered additional scrutiny of the research.  Yet, this guardrail did not 
work.  According to NIH, EcoHealth Alliances year 5 progress report indicated that EcoHealth 
Alliance should have provided immediate notification for research that triggered this special 
reporting condition.  However, EcoHealth Alliance never provided such notice.  
 
NIH generally concurred with the audits nine recommendations to address causes of our 
findings and ways to improve NIH oversight going forward.   The recommendations include 
improving how NIH staff assess research for review under the HHS P3CO Framework, defining 
 
3 The HHS Framework for Guiding Funding Decisions about Proposed Research Involving Enhanced Potential 
Pandemic Pathogens (HHS P3CO Framework). 
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what it means to get immediate notification from a grantee, and implementing enhanced 
oversight for foreign subrecipients.  We recommended that NIH consider referring the Wuhan 
Institute of Virology (WIV) for debarment by HHS.  NIH provided documentation that one 
recommendation related to recovering unallowable costs is likely implemented and there is 
evidence that NIH is implementing another recommendation related to ensuring that NIH 
employees are following NIH internal policy to refer research for review under the HHS P3CO 
Framework.  
 
The report also includes findings related to EcoHealth Alliances ability to obtain documentation 
from WIV.  Since 2021, EcoHealth Alliance has been unable to obtain such documentation 
because WIV is no longer cooperating.  This finding raises questions about how to address real 
challenges with oversight of subrecipients.  Our audit recommends that NIH enhance its 
monitoring, documentation, and reporting requirements to mitigate risks and ensure that NIH can 
appropriately oversee the use of NIH funds by foreign recipients and subrecipients.   
 
Our report also made six recommendations for EcoHealth Alliance to improve its compliance 
with NIH grant requirements and its oversight of subrecipients and recommended that EcoHealth 
Alliance refund certain unallowable costs of approximately $90,000.  
 
This audit demonstrates the importance of sound grants management.  Although it may seem 
bureaucratic, grants management is a fundamentally important role of NIH and its recipients.  It 
is one way NIH ensures that the public and the scientific community get the benefit of research 
funded by American taxpayer dollars.  It is crucial for potentially high-risk research.  With good 
grants management, NIH can mitigate potential serious risk associated with such research.  
Although the issues related to specific types of research and science may be complex, improving 
grants managementgetting the basics rightneed not be.     
 
PROTECTING HEALTH CARE: CMS 
Overview of OIG Oversight of CMS 
HHS-OIGs oversight of CMS helps protect health care for more than 150 million individuals 
who are covered by Medicare and Medicaid, or nearly 45 percent of all Americans, including 
seniors, individuals with disabilities, low-income families and individuals, and individuals with 
end-stage renal disease.  Effectively and efficiently managing these complex health care 
programs is a top challenge for CMS.  These programs use multiple delivery models; cover a 
broad array of health conditions, providers, services, settings, and insurance plans; and operate 
pursuant to intricate statutory directives and regulatory structures.  Spending on these programs 
is massive, totaling more than $1.6 trillion in FY 2021, with $875 billion and $752 billion, 
respectively, spent on Medicare and Medicaid, the Nations two largest health insurance 
programs. 
Decades of HHS-OIG enforcement and oversight prove the adage that fraudsters follow the 
money.  Our work reflects the difficulties in reducing errors in claims filing and payment in 
sprawling, complex programs.  CMSs programs rapidly change and evolve, and some programs 
are administered collaboratively with States and private insurance companies.  The complexity, 
breadth, and rapid change in CMS programs make effective oversight complex, challenging, and 
resource intensive. 
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In short, CMSs responsibilities are broad, with correspondingly critical needs for rigorous 
oversight and enforcement.  Approximately 80 percent of OIGs resources are appropriated for 
oversight of CMS.  We target prevention of problems in the first instance, prompt detection 
when problems occur, and rapid enforcement when problems rise to the level of fraud or abuse.  
OIG work examines how CMS programs are designed and whether they achieve their goals, such 
as cost-effectiveness and quality of care.  We identify harmful behavior (e.g., upcoding, stinting 
on care, or misreporting of data).  Our work consistently shows that program risks in Medicare 
and Medicaid can have huge impacts on enrollees and their access to necessary care and 
potentially result in improper payments that cost taxpayers hundreds of millions of dollars.   
OIGs oversight of the Medicare Advantage program is a key example.  Over the past 10 years, 
Medicare Advantage enrollment has increased significantly.  It now covers more than 30 million 
Medicare enrollees and is expected to cover 50 percent of all enrollees soon.  Rapid expansion 
has come with growing pains that have strained managed care program integrity and highlighted 
compliance weaknesses in managed care plans.  For example, OIGs audits, evaluations, and 
investigations have examined aspects of Medicare Advantage risk adjustment, including 
potentially inflated payments to plans and concerns that plans risk adjustment data indicate 
enrollees with serious medical conditions may not be receiving needed care.  Our work has also 
raised concerns regarding improper denials of Medicare covered services.  Our work 
demonstrates that risks of fraud, waste, and abuse in managed care are real and significant.  
These risks not only threaten the financial integrity of Medicare, but also potentially affect 
enrollees health care.   
OIGs broad portfolio of CMS oversight includes work aimed at improving nursing home care; 
protecting people from abuse and neglect in institutional settings; identifying misspent funds and 
reducing improper payments; improving hospice and home and community-based services; 
improving quality of care; combating the opioid crisis; increasing equitable access to needed 
treatment and services, including for substance abuse and serious mental illness; reducing 
spending on prescription drugs; ensuring effectiveness of new technologies; and strengthening 
program integrity.  Although our oversight is extensive and we continue to improve our 
efficiency with modern data tools and approaches, our capacity is not commensurate with all that 
should be done to provide effective oversight of Medicare and Medicaid.   
Combating Fraud and Abuse in Medicare and Medicaid 
Across Medicare and Medicaid, HHS-OIG is aggressively combating fraud and abuse to protect 
taxpayer dollars from theft and misuse and to protect patients from harm.  Combating fraud in 
Medicare and Medicaid has been a longstanding and continuing challenge.  Pinpointing the total 
amount of health care fraud is difficult.  According to research estimates, between 3 percent and 
10 percent of total health care spending in the United Statesroughly $129 billion to $430 
billionis lost to fraud each year.4  
Twenty years ago, most types of fraud were geographically limited and often used false 
storefronts, direct mail campaigns, and local television ads.  More recently, OIG and our law 
enforcement partners have seen health care fraud schemes that use sophisticated telemarketing 
 
4 Journal of the American Medical Association, Waste in the US Health Care System: Estimated Costs and Potential 
for Savings; Eliminating Waste in US Health Care; and Federal Bureau of Investigation, 2009 Financial crimes 
report (available at http://www.fbi.gov/stats-services/publications/financial-crimes-report-2009). 
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scams and other methods to expand the reach of the fraud.  These schemes are designed to 
maximize the scale of fraud, be efficient and fast moving, and generate higher returns.  By 
manipulating technology, fraudsters can take a local scheme, make it active in all 50 States, and 
sometimes involve criminals operating internationally.   
For example, in an enforcement action dubbed Operation Double Helix, OIG, the Department of 
Justice, and other law enforcement partners took swift action to disrupt one of the largest fraud 
schemes in history, involving more than $1.4 billion in suspect billing.  Fraudsters deliberately 
targeted Medicare patients and expensive genetic cancer tests, for which Medicare typically paid 
between $10,000 to $18,000 per test.  A combination of aggressive telemarketers, sham 
telemedicine companies, doctors, and laboratories worked together to operate this scheme 
nationwide.  The investigation started when OIG received a tip.  OIGs subsequent data analysis 
found what appeared to be an excessive amount of billing for expensive genetic cancer tests.  
Boots-on-the ground agents followed up on these data to uncover the underlying fraud.  Just 9 
months after receiving the tip, OIG and our law enforcement partners took action against 35 
defendants to shut down this scheme.   
Operation Double Helix demonstrated the dramatic difference in fraud-fighting speed from just 5 
or 6 years ago.  These faster efforts also have a deterrent effect.  In the 3 months after this 
operation, there was a 35-percent reduction in billings for the affected genetic cancer tests.  The 
operation was accompanied by the publication of a Special Fraud Alert to warn the public about 
the fraud scheme and the aggressive marketing tactics being used.  
This is just one example from a large body of OIGs work to fight health care fraud.  Each year, 
HHS-OIG and our law enforcement partners conduct hundreds of criminal, civil, and 
administrative investigations of a wide range of conduct that threatens the health and welfare of 
individuals and the integrity of Federal health care programs.  For example, fraud investigations 
related to Medicare and Medicaid address patient harm, unlawful kickback schemes, submission 
of false claims for payment, and illegal billing, sale, and diversion of prescription drugs.  HHS-
OIG conducts investigations regarding organized criminal activity, including medical identity 
theft and other schemes established for the sole purpose of stealing Medicare and Medicaid 
dollars.  Fraudsters face heavy fines and jail time.  OIG has and uses its authority to exclude 
convicted perpetrators and other untrustworthy actors from participation in Federal health care 
programs.  
Investigating fraud is not HHS-OIGs only tool to combat fraud.  Detecting program integrity 
risks in new or changing programs helps mitigate potential fraud schemes before they can 
significantly affect Medicare and Medicaid.  For example, OIG assessed fraud and abuse risks 
associated with the significant increase in the use of telehealth as a covered service in Medicare 
during the public health emergency.  Our report identified 1,714 providers (out of 742,000) 
whose billing for telehealth services posed a high risk to Medicare.  We recommended that CMS 
provide targeted oversight of such providers to reduce risk.  This report and other HHS-OIG 
oversight work informs policymakers and stakeholders about potential program vulnerabilities so 
that they can take steps to mitigate the risk of fraud before it becomes a widespread problem.   
Unwinding the PHE 
HHS faces substantial, ongoing challenges in ensuring accountability for pandemic response 
funding.  In the coming weeks, CMS must be attentive to unwinding certain aspects of its 
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response to the PHE.  CMS must plan for and manage risks associated with termination of the 
waivers and flexibilities it afforded health care providers and States as they revert to pre-
pandemic rules.   
OIG has started an audit to examine a potential risk to Medicaid during the unwinding of the 
PHE: redeterminations of Medicaid eligibility.  As a condition for receiving a temporary increase 
in Medicaid funding as authorized under the Families First Coronavirus Response Act (FFCRA), 
as amended by the Consolidated Appropriations Act, 2023, States were required to maintain 
enrollments of most people enrolled in Medicaid as of March 18, 2020, through March 31, 2023.  
States are beginning the process to redetermine eligibility for millions of people covered through 
Medicaid and the Childrens Health Insurance Program.  CMS issued guidance to States to 
complete redeterminations by the end of 2023.  OIGs new work builds on prior OIG audits that 
identified problems with the accuracy of Medicaid eligibility determinations before the PHE.  
Problems included human and system errors that resulted in inaccurate eligibility determinations, 
such as a caseworker not assessing required income documentation and improperly determining 
an individual eligible, or system errors that prevented a State from verifying information from 
other Government agencies. 
LOOKING FORWARD: KEEPING PACE WITH FRAUD, WASTE, AND ABUSE IN 
HHS PROGRAMS 
Notwithstanding rigorous efforts by OIG and support from Congress, the Administration, and 
HHS for OIG work and resources, serious fraud, waste, and abuse continue to threaten HHS 
programs and the people they serve.  HHS-OIG lacks a sufficient number of agents to work cases 
and auditors, data scientists, and analysts to detect trends, outliers, and program vulnerabilities.  
OIG is turning down between 300 and 400 viable criminal and civil health care fraud cases each 
year.  Each case means unaddressed potential fraud and missed opportunities for deterrence.  
OIGs Regional Offices reviewed and evaluated more than 1,780 Hotline complaints in FY 2021 
and more than 3,562 in FY 2022 that might have developed into viable cases, but we did not 
have resources to open additional cases.  In addition to the cases noted above, last year OIG 
turned down 648 cases from the major case coordination effort we have with CMS, a nearly 10-
percent increase in the percentage of cases declined from the prior year.  These uninvestigated 
cases represent real, potential unchecked fraud and the potential for patients to be put in harms 
way.   
I do not want to give the impression that we are not addressing serious fraud and abuse.  We are, 
and our statistics and return on investment show it.  However, with current resources we cannot 
keep up with the level of threat to HHS, patients, and taxpayer dollars.  .Every day we make 
tough choices on cases and issues to decline.  For example, we have declined referrals from the 
Drug Enforcement Administration for cases tied to the opioid epidemic, including allegations of 
a physician providing medically unnecessary prescriptions that led to overdose deaths, and 
hospice fraud cases involving patients receiving false diagnoses of terminal illnesses for which 
hospice providers received millions of dollars in reimbursement.  OIGs agents and digital 
investigators are in high demand by prosecutors for their unparalleled expertise in HHSs 
complex health care programs and the fraud schemes that exploit them.   
The FY 2024 Presidents Budget requested resources for OIG that, if enacted, would go a long 
way toward addressing this shortfall, particularly with respect to combating fraud, waste, and 
abuse in Medicare and Medicaid, for which the Presidents Budget requests approximately 
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$52.5 million in additional funding for OIG in FY 2024.  The Presidents Budget also requests 
urgently needed funding for oversight of HHSs emergency preparedness and response.  
Looking beyond FY 2024, we foresee a need for significant additional resources to oversee other 
HHS programs, including the UC Program and NIH grant programs I have focused on today, as 
well as other grant programs operated by NIH, the Health Resources and Services 
Administration, ACF, and other agencies.  Current funding allows OIG to audit and evaluate 
only a small portion of HHS grant outlays and limits our ability to hold wrongdoers accountable.  
Our work consistently demonstrates that rigorous oversight uncovers where HHSs awarding 
process and its awards are improperly managed, funds are misspent, and health and safety are put 
at unnecessary risk.  The size of HHS grants programs underscores the urgency of uncovering 
and sealing gaps in integrity. 
The massive spending on HHS grants makes them an attractive target for fraud.  However, OIG 
lacks the resources to do essential investigative work in programs with significant fraud risk. 
Over the past 5 years, there has been a more than sevenfold increase in the number of complaints 
to OIGs Hotline related to programs other than Medicare and Medicaid that OIG declined to 
investigate due to lack of resources.  With more resources, OIG would better detect and root out 
fraud in HHSs grant programs, returning stolen money to the American people and enhancing 
the integrity of HHS programs. 
CONCLUSION 
I appreciate the opportunity to discuss OIGs mission-critical oversight and enforcement across 
three important topic areas that well illustrate both the range and complexity of programs HHS-
OIG is responsible for overseeing and the broad spectrum of risk areas and actionable 
recommendations we have identified.  As Inspector General for HHS, I am committed to using 
our resources as efficiently and effectively as possible to prevent, detect, and combat fraud, 
waste, and abuse in HHS programs.  However, at current funding levels, HHS-OIG risks falling 
behind, unable to keep pace with threats to HHS programs or deliver the volume of oversight and 
enforcement needed to identify and mitigate risks, protect people from harm, and hold 
wrongdoers accountable.  I look forward to working with the members of this Subcommittee and 
HHS to continue to address unmet oversight needs for the benefit of the American taxpayers and 
the people served by HHS programs.   
I would be happy to take questions.  
  
 
 
 
 
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