Monday, November 28, 2011

OIG-HHS Reports its Accomplishments for 2011 and Priorities for 2012

The Office of Inspector General ("OIG") for the U.S. Department of Health & Human Services has recently issued its 2011 Fall Semi-Annual Report as well as the OIG Work Plan for 2012.  For those of you wanting to know what's "hot" in health care fraud and abuse and what will be the OIG's areas of investigative focus in 2012, these are two important sources.

Mintz Levin's Health Law & Policy Matters Blog ("HLPM") has summarized some of the highlights of both the Report and Plan.  For those not wishing to review the lengthy report, the Report's "Highlights" section summarizes the Semi-Annual Report's main points.  As HLPM explains:  the Semi-Annual Report "describes the actions the agency undertook between April 1 and September 30, 2011 and summarizes its Medicare and Medicaid claims reviews and its legal, investigative, and monitoring activities," the later of which include "enhanced data mining, predictive analytics, trend evaluation, and modeling technology" aimed at strengthening the OIG's ability to identify, investigate and prevent health care fraud, waste, and abuse. 

As for the 2012 Work Plan, HLPM notes that the OIG's  focus on investigating fraud and abuse will include the following areas:
  • "Home health: monitoring of “questionable billing characteristics” of home health services;
  • Home health: Medicare administrative contractors’ oversight of home health agency claims;
  • Hospitals: hospital claims with high or excessive payments;
  • Nursing homes: questionable billing patterns during non-Part A nursing home stays;
  • Medical equipment and supplies: questionable billing for Medicare diabetic testing supplies; and
  • Ambulance: questionable billing for ambulance services."

No comments:

Post a Comment