On January 21, 2026, OIG released the Fall 2025 Semiannual Report to Congress, summarizing its activities between April 1, 2025, and September 30, 2025.
The Fall 2025 Semiannual Report (the “Report”) begins with a message from the Inspector General that provides a summary of OIG’s accomplishments, including its financial impact, its partnership with law enforcement concerning health care fraud, and its oversight activities. The Report highlights OIG’s monetary impact of $2.43 billion, which reflects $12.70 in expected recoveries and receivables for every $1 invested in OIG’s work.
The Report focuses on OIG’s activities in six main categories: (1) combatting health care fraud, (2) strengthening financial integrity, (3) protecting patients from harm, (4) addressing public health crises, (5) advancing excellence in health and human service programs, and (6) strengthening cybersecurity.
Combating Health Care Fraud
- OIG used advanced data analytics to detect trends for additional follow-up from HHS programs or investigations, including, for example, skin substitutes and remote patient monitoring.
- OIG’s investigation of health care fraud and abuse during this period led to 352 criminal actions and 481 civil actions. This included the “largest health care fraud takedown in DOJ and OIG history,” which concerned durable medical equipment fraud, diagnostic testing, telemedicine, wound care, and drug diversion.
- OIG excluded 1,336 individuals and entities from participation in federal health care programs and partnered with Medicare Fraud Control Units on 1,115 joint investigations.
Strengthening Financial Integrity
- OIG’s oversight includes preventing and detecting improper payments, including, for example, improper autism service payments and provider relief payments.
- During this period, OIG also identified $146.4 million in potential savings and issued 195 recommendations “aimed at strengthening program performance and integrity.” This includes, for example, estimations regarding trauma team activation claims and charges that did not comply with Federal or Medicare requirements and payments for evaluation and management services that were provided on the same day as eye injections that were at risk for noncompliance with Medicare requirements.
- OIG has also prioritized oversight of managed care, including conducting “comprehensive financial reviews, detecting and preventing fraud within managed care plans, and ensuring payment accuracy.” This includes, for example, high-risk diagnosis codes, medical loss ratio remittances, MCO payments for personal care assistant services, and MCO fraud, waste, and abuse referrals.
Protecting Patients from Harm
- OIG’s oversight also focuses on fostering patient safety, advancing nursing home resident safety, and enforcement actions against abusive providers.
- The Report includes several examples of this oversight including:
- Hospital identification of patient harm events
- Patient Safety Organization programs
- Safety in intermediate care facilities
- Rates at which Medicare enrollees leave hospitals against medical advice
- Enforcement actions to address “grossly substandard care in nursing homes” and ensure nursing home quality of care (such as preventing falls and complying with staff background checks)
Addressing Public Health Crises
- OIG focuses on the substance use disorder crisis and the behavioral health crisis.
- Examples of OIG’s actions include:
- Addressing gaps in substance abuse treatment services
- Access to medication to treat opioid use disorder
- Enforcement actions to address illegal prescribing and distribution of opioids and other controlled substances
- Behavioral health provider availability
- Suicide-related follow-up care for children
- Enforcement actions against behavioral health providers
Advancing Excellence in Health and Human Service Programs
- OIG conducts oversight regarding the costs and outcomes of HHS programs, including, for example, the following actions:
- Controlling the grant payment system
- Contract awarding, monitoring, and closeout
- Sanitation facilities construction program projects
- Domestic food facility inspections
Strengthening Cybersecurity
- OIG provides oversight of the Department’s cybersecurity, with a focus on protecting information systems and technology that store or use sensitive data, including risks to genomic data, and oversight of contractor cybersecurity.
The Report also addressed the impact of its recommendations, summarizing its finding that the 195 recommendations it issued identified $983.9 million “in questioned costs and funds put to better use.”
The full Report can be found here.
