US Health Watchdog Expects $5.56 Billion in Recoveries and Savings

Source: US News & World Report/Reuters

July 13, 2026, at 12:03 a.m.


WASHINGTON, July 13 (Reuters) - The federal watchdog for the U.S. health ⁠department ⁠generated $5.56 billion in expected recoveries and projected ⁠savings over six months and barred 1,212 individuals and companies from federal programs, it said on Monday, ​even as its overall enforcement activity fell to the lowest level in two years. The decline complicates the Trump administration's portrayal of an unprecedented crackdown on ‌healthcare fraud.

The Department of Health and Human ‌Services Office of Inspector General, in a semiannual report to Congress covering October through March, said it returned $12.70 for every dollar it spent. The headline ⁠figure was anchored ⁠by a handful of large cases, including a 15-year prison sentence for a telemedicine software ​executive behind a $1 billion scheme and $674 million in settlements with Kaiser Permanente affiliates and CVS Health's Aetna over inflated Medicare Advantage billing.

ENFORCEMENT ACTIONS DROP

But the dollars mask a shrinking caseload. Combined criminal and civil actions fell to 604, down from 833 in the prior period and the lowest in at least two ​years. The OIG said it had excluded 1,212 individuals or entities from the Medicare program as the result of its investigations, continuing ⁠a ⁠steady two-year slide from 1,795, and ⁠criminal referrals dropped to 1,168 ​from 1,451. The report showed no surge in enforcement relative to the comparable period under the Biden administration; casework was ​essentially flat, then fell.

SCORING METHODOLOGY SHIFTS

The OIG's ⁠headline figure is complicated by a change in how the office keeps score.

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