The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has released its Spring 2026 Semiannual Report to Congress, summarizing its oversight and enforcement work from October 1, 2025, through March 31, 2026. Led by Inspector General T. March Bell, the report shows an office that generated $5.56 billion in monetary impact and excluded 1,212 individuals and entities from federal healthcare programs during the six-month period.
As the largest Inspector General’s office in the federal government, HHS-OIG is tasked with protecting the integrity of the hundreds of billions of dollars that move through Medicare, Medicaid, and other HHS programs every year. In 2025 alone, Medicare Advantage covered nearly 35 million enrollees and accounted for $537 billion in Medicare spending, while Medicaid managed care organizations served more than 66 million enrollees nationwide. Every dollar the OIG helps protect matters, and its work continues to pay for itself many times over.
Did You Know?
For every $1 invested in OIG, the office returned $12.70 to the federal government during this reporting period. That return climbs to $15.20 for every $1 spent specifically on OIG’s Medicare and Medicaid oversight, based on a 3-year rolling average through FY 2025.What Is the HHS-OIG Semiannual Report to Congress?
Twice a year, HHS-OIG reports to Congress on its work identifying significant risks, problems, deficiencies, and investigative outcomes across HHS programs, as required under the Inspector General Act of 1978. Reports cover the periods ending March 31 (spring) and September 30 (fall).
You can read the full Spring 2026 Semiannual Report directly from OIG, or browse OIG’s full library of reports.
Key Numbers from the Spring 2026 Report
- $5.56 billion in total monetary impact — combining investigative receivables, audit and evaluation receivables, and funds identified for better use — more than double the $2.43 billion reported for Fall 2025.
- 317 criminal actions and 287 civil actions resulting from OIG investigations.
- 1,212 individuals and entities excluded from federal health care programs — 1,183 individuals and 29 entities.
- 40,815 hotline tips evaluated, leading to 21,371 referrals for further action.
- $510 million in questioned costs and $447.6 million in funds put to better use, spanning 173 new recommendations across 77 audits and evaluations.
Notable Enforcement Actions
Even with a quieter six months by recent standards, OIG’s casework this period was far from small. A few of the report’s standout actions:
- Telemedicine fraud: The CEO of a healthcare software company was sentenced to 15 years in prison and ordered to pay $452 million in restitution for a telemedicine and durable medical equipment scheme worth more than $1 billion.
- ACA enrollment fraud: An insurance brokerage executive and a marketing firm CEO were each sentenced to 20 years in prison and ordered to pay $180.6 million in restitution for a $233 million scheme that enrolled vulnerable individuals in ACA plans without their consent.
- Wound care fraud: The owners of several wound graft companies were sentenced to prison and ordered to pay restitution after directing unwarranted, oversized bioengineered skin grafts, resulting in more than $1.2 billion in fraudulent claims.
- Medicare Advantage settlements: Five Kaiser Permanente affiliates agreed to pay $556 million, and Aetna agreed to pay $117.7 million, to resolve False Claims Act allegations tied to inflated Medicare Advantage risk-adjustment diagnoses.
Program Exclusions: OIG's Most Powerful Administrative Tool
An exclusion is one of the most severe actions the OIG can take against a provider or entity. Once excluded under section 1128 of the Social Security Act, an individual or organization cannot bill or be paid by any federal healthcare program — including Medicare, Medicaid, CHIP, TRICARE, and others. In practice, an exclusion is a barrier to working anywhere in healthcare.
This period’s 1,212 exclusions ranged widely — from a Texas rheumatologist excluded for 50 years over more than $118 million in false claims, to a pharmaceutical CEO barred for 15 years over misleading stem-cell product claims. The scale adds up quickly: as of today, the HHS-OIG List of Excluded Individuals and Entities (LEIE) contains 83,638 excluded individuals and entities. Layer in state Medicaid exclusion lists — 91,584 of them — and the total grows to 175,222 combined federal and state exclusion records that healthcare organizations need to be screening against.
That state total matters because state and federal lists don’t always move together. State exclusions can take months to be reflected on the federal LEIE, which means relying on the LEIE alone leaves real gaps in coverage. (We break down exactly how OIG, GSA-SAM.gov, and state Medicaid exclusion lists differ if you want the full picture.) That’s exactly the gap ProviderTrust’s automated exclusion list monitoring is built to close.
OIG's Continued Fight Against Medicaid Fraud
Medicaid accounts for nearly $1 out of every $5 spent on healthcare in the U.S., which makes it a persistent target for fraud. In fiscal year 2025, Medicaid Fraud Control Units (MFCUs) — which operate in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands — secured 1,185 convictions, 900 exclusions, and 674 civil settlements and judgments, recovering more than $2 billion. For more on how MFCUs operate and what their annual results tend to reveal, revisit our recap of the Medicaid Fraud Control Units’ annual report.
What This Means for Your Compliance Program
HHS-OIG’s Spring 2026 numbers tell a familiar story: healthcare fraud remains widespread, and OIG, DOJ, and state MFCUs continue to hold both large-scale schemers and smaller individual bad actors accountable. Whether enforcement activity ticks up or down from one report to the next, the exclusion list keeps growing — and so does the risk of unknowingly employing, contracting with, or paying an excluded individual or entity.
For compliance, HR, and credentialing teams, ongoing exclusion monitoring — not just a one-time check — is the baseline for staying ahead of OIG’s enforcement activity.
How ProviderTrust Can Help
Since 2010, ProviderTrust has helped hospitals, health systems, payers, and post-acute care organizations stay ahead of exactly this kind of risk. We monitor more than 14 million people and entities on an ongoing basis against the OIG LEIE, GSA SAM.gov, state Medicaid exclusion lists, the CMS Preclusion List, OFAC, and more — and our enhanced primary-source data catches exclusions that other vendors miss. In fact, 51 percent of the exclusions we’ve discovered were likely missed elsewhere.
Ready to close the gap between what your current process catches and what’s actually out there? Get started with ProviderTrust’s exclusion list monitoring today.