The OIG Work Plan: What Is It and Why Should I Care?

August 9th, 2019 - Namas
Categories:   Allergy|Immunology   Anesthesia|Pain Management   Behavioral Health|Psychiatry|Psychology   Cardiology|Vascular   Chiropractic   Dermatology|Plastic Surgery   ENT|Otolaryngology   Home Health|Hospice   Laboratory|Pathology   Neurology|Neurosurgery   Obstetrics|Gynecology   Office of Inspector General (OIG)   Oncology|Hematology   Ophthalmology   Optometry   Oral and Maxillofacial Surgery   Orthopedics   Pediatrics   Physical Medicine|Physical Therapy   Podiatry   Practice Management   Primary Care|Family Care   Pulmonology   Radiology   Rheumatology   Skilled Nursing   Urology|Nephrology  
0 Votes - Sign in to vote or comment.

The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within the U.S. government system. Most of OIG's resources go towards overseeing the Medicare and Medicaid programs, mostly through a nationwide network of audits, investigations, and evaluations in an effort to promote cost savings and make policy recommendations. Additionally, OIG assists in the development of cases for criminal, civil, and administrative enforcement agencies.

In 2018 alone, "investigations conducted by HHS-OIG resulted in 679 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 795 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties ('CMP') settlements, and administrative recoveries related to provider self-disclosure." [ 1] These investigations and disclosures resulted in over $2.3 billion in healthcare fraud judgments and settlements. These numbers have been increasing every year and financial recovery of alleged overpayments has become a huge and lucrative business for the contractors selected by the government to conduct provider audits.

Healthcare providers, organizations, compliance officers, and auditors should all keep abreast of the OIG's audit targeting process by following the OIG's Work Plan. In its own words, the OIG Work Plan "sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond by OIG's Office of Audit Services and Office of Evaluation and Inspections." [2] The OIG plans its work by assessing relative risks in various HHS programs and operations to identify areas it believes are in need of audit scrutiny. Once that's done, priorities are set for the sequence and proportion of resources to be allocated. The work portfolio also includes several legal and investigative activities.

The OIG's Active Work Plan Items can be found at https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp. An item recently added to the work plan which impacts several of my personal clients was announced in June 2019 and is titled "Review of Medicare Part B Claims for Intravitreal Injections of Eylea and Lucentis." This work plan item specifically pertains to ophthalmology practices and, if you click on the item in the work plan, you can find more information on what the OIG is specifically targeting. In this case, it states that "[OIG] will review claims for intravitreal injections of Eylea and/or Lucentis and the other services billed on the same day as the injection, including evaluation and management services, to determine whether the services were reasonable and necessary and met Medicare requirements." [3]

 The work plan is updated monthly and it "will evolve as OIG continues to pursue complete, accurate, and timely public updates regarding our planned, ongoing, and published work." For anyone involved in healthcare, whether a provider or an auditor, it's always good to have your finger on the pulse of what items and areas the government is actively auditing and investigating. If you're not doing it already, the OIG Work Plan is a good resource and is worth a bookmark in your Internet browser.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

HIPAA Penalty Changes
January 11th, 2021 - Wyn Staheli, Director of Research
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
CDT and CPT - The Same but Different!
December 8th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
COVID Vaccine Codes Announced
November 11th, 2020 - Wyn Staheli, Director of Research
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Are You Aware of the 2021 Star Rating System Updates?
November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...
Special Needs Plans Help Beneficiaries and Risk Adjustment Reporting
October 22nd, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association