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OIG 2012 WORK PLAN
Posted on Dec 7, 2011 OIG 2012 WORK PLAN
Each year the OIG announces what they will investigate on behalf of Medicare for the coming year. Per the OIG:
“Our organization was created to protect the integrity of HHS programs and operations and the wellbeing of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal laws. Our mission encompasses the more than 300 programs administered by HHS at agencies such as the Centers for Medicare & Medicaid Services, National Institutes of Health, Food and Drug Administration, Centers for Disease Control and Prevention, and Administration for Children and Families.
As required by statute, the majority of our resources are directed toward safeguarding the integrity of the Medicare and Medicaid programs and the health and welfare of their beneficiaries. Consistent with our responsibility to oversee all departmental programs, we also focus considerable effort on HHS’s other programs and management processes, including key issues, such as food and drug safety, child support enforcement, conflict¬of¬interest and financial disclosure policies governing HHS staff, and the integrity of departmental contracts and grants management processes and transactions. Our core organizational values are:
� Integrity: Acting with independence and objectivity.
� Credibility: Building on a tradition of excellence and accountability.
� Impact: Yielding results that are tangible and relevant.”
The OIG investigates a broad spectrum of services throughout the medical industry, including hospitals, nursing facilities, health plans, home health, hospice, medical equipment and supplies, Medicare providers, programs, prescriptions, etc.
Of interest to physicians, the plan includes the following investigational targets for 2012:
� Physicians and Other Suppliers: High Cumulative Part B Payments
� Physician¬Owned Distributors of Spinal Implants
� Physicians: Place¬of¬Service Errors
� Physicians: Incident¬To Services
� Physicians: Impact of Opting Out of Medicare
� Chiropractors: Part B Payments for Services
� Ambulatory Surgical Centers: Payment System
� Ambulatory Surgical Centers and Hospital Outpatient Departments: Safety and Quality of Surgery and Procedures
� Evaluation and Management Services: Trends in Coding of Claims
� Evaluation and Management Services Provided During Global Surgery Periods
� Evaluation and Management Services: Use of Modifiers During the Global Surgery Period
� Evaluation and Management Services: Potentially Inappropriate Payments
� Part B Imaging Services: Medicare Payments
� Independent Therapists: Outpatient Physical Therapy Services
� Sleep Disorder Clinics: Medicare Payments for Sleep Testing
� Sleep Testing: Appropriateness of Medicare Payments for Polysomnography
� Diagnostic Radiology: Excessive Payments
